title: Clinical aspects of ballistic peripheral nerve injury: shrapnel versus gunshot.
abstract: OBJECTIVE
  Ballistic injuries to peripheral nerves pose special challenges in terms of indications, timing and type of surgical intervention. The aim of the present work was to analyze our experience in the surgical treatment of peripheral nerve ballistic injuries with respect to the mechanism of injury (gunshot versus shrapnel), and identify common and dissimilar prognostic factors in both types of injury.
  
  
  METHODS
  This study was conducted on 42 patients totaling 58 nerves. Twenty-two patients (32 nerves) were injured by gunshot and 20 patients (26 nerves) by shrapnel. Median postoperative follow-up was 33 months (range 12 months to 14 years).
  
  
  RESULTS
  Overall postoperative outcome appears to be more favorable for gunshot-wound (GSW) patients than shrapnel-injured patients, especially in terms of neuropathic pain relief (75 % vs. 58 % respectively, p < 0.05). Presence of foreign particles in shrapnel injured patients has a negative impact on the surgical outcome in terms of rate of pain improvement (28 % compared to 67 % in patients with and without foreign particles, respectively). Nerve graft reconstruction, rather than neurolysis, seems to be the more beneficial treatment for shrapnel-induced neuropathic pain (100 % vs. 47 % in improvement rate, respectively). Early surgical intervention (median 2 months after injury) significantly relieved neuropathic pain in 83 % of shrapnel-injured patients compared to 58 % in patients operated later.
  
  
  CONCLUSIONS
  This study suggests that shrapnel injury is more destructive for nerve tissue than gunshot injury. Our impression is that early surgical intervention in shrapnel injuries and split nerve grafting (especially when small fragments are recognized in the nerve) significantly improve the patient's functional activity and quality of life.
authors.affiliation: Division of Peripheral Nerve Reconstruction, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel, rochkind@zahav.net.il.
authors.forename: Shimon
authors.initials: S
authors.lastname: Rochkind
authors.forename: Ido
authors.initials: I
authors.lastname: Strauss
authors.forename: Zvi
authors.initials: Z
authors.lastname: Shlitner
authors.forename: Malvina
authors.initials: M
authors.lastname: Alon
authors.forename: Evgeny
authors.initials: E
authors.lastname: Reider
authors.forename: Moshe
authors.initials: M
authors.lastname: Graif
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*; D055815:Young Adult