Examination

  • Examine the peripheral nervous system for all injuries and document findings.
  • Repeat examination after any manipulation or surgery.

Management

  • Reduce fractures/dislocations urgently if there is an associated nerve injury.
  • The following requires appropriate surgical expertise to explore the wounds:
    • Laceration near a nerve associated with a neurological deficit.

Investigations

  • Neurophysiology is rarely needed acutely and must not delay referral or treatment.
  • MRI can assist in surgical planning but is not essential and surgery should not be delayed waiting for scan.

Surgery

  • Explore the nerve during internal fixation of fractures associated with nerve injury except axillary nerve (with low energy shoulder trauma) and Lumbosacral plexus injury (during sacroiliac screw fixation).
  • Document exploration of the nerve in the notes and the proximity of the nerve to any internal fixation device.
  • Nerves damaged during surgery should undergo urgent repair.
  • If a divided nerve is found during surgery:
    • If skilled and able, repair the nerve.
    • If not, oppose nerve with fine coloured sutures & Refer.

Post-surgery Complications

If a new vascular or nerve deficit post-surgery develops:

  • Loosen bandages
  • Split plaster of paris to the skin
  • Gentle repositioning of limb
  • If no improvement, consider re-exploration.

Explore painful post-operative paralysis urgently, it could be:

  • Compartment syndrome
  • Nerve compression from:
    • Bone fragments
    • Suture
    • Haematoma
    • Hardware.

 Explore pain and progressive loss of sensation urgently as critical ischaemia is likely.