title: Treatment of penetrating trauma of the extremities: ten years' experience at a Dutch level 1 trauma center.
abstract: BACKGROUND
  A selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess and treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in which adjuvant investigations or interventions are not routinely performed, but based on physical examination only.
  
  
  METHODS
  All subsequent patients presented with PTE at a Dutch level I trauma center from October 2000 to June 2011 were included in this study. In-hospital and long-term outcome was analysed in the light of assessment of these patients according to the SNOM protocol.
  
  
  RESULTS
  A total of 668 patients (88.2% male; 33.8% gunshot wounds) with PTE presented at the Emergency Department of a level 1 traumacenter, of whom 156 were admitted for surgical treatment or observation. Overall, 22 (14%) patients that were admitted underwent exploration of the extremity for vascular injury. After conservative observation, two (1.5%) patients needed an intervention to treat (late onset) vascular complications. Other long-term extremity related complications were loss of function or other deformity (n = 9) due to missed nerve injury, including 2 patients with peroneal nerve injury caused by delayed compartment syndrome treatment.
  
  
  CONCLUSIONS
  A SNOM protocol for initial assessment and treatment of PTE is feasible and safe. Clinical examination of the injured extremity is a reliable diagnostic 'tool' for excluding vascular injury. Repeated assessments for nerve injuries are important as these are the ones that are frequently missed and result in long-term disability.
  
  
  METHODS
  II / III, retrospective prognostic observational cohort study Key words Penetrating trauma, extremity, vascular injury, complications.
authors: Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, The Netherlands. o.vanwaes@erasmusmc.nl
authors: Oscar J F
authors: OJ
authors: Van Waes
authors: Esther M M
authors: EM
authors: Van Lieshout
authors: Wouter
authors: W
authors: Hogendoorn
authors: Jens A
authors: JA
authors: Halm
authors: Jefrey
authors: J
authors: Vermeulen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult