Missile-caused median nerve injuries: results of 81 repairs

Abstract

Background Missile-caused median nerve injuries have rarely been reported in current literature. We present repair outcome for all median nerve injuries in which the median nerve was severed either by missile injury or secondarily in the subsequent resection of a neuroma in continuity. Methods Prospective study included 81 casualties with proximal, intermediate, or distal complete median nerve lesions, repaired by nerve graft or direct suture. Final outcome was defined at least 4 years postoperatively, on the basis of motor recovery, sensory recovery, neurophysiological recovery, and patient's judgment on the outcome, each estimated by 0 to 5 points and according to the total sum, as poor, insufficient, good, or excellent. The last 2 modalities were considered to be successful. Results Successful outcome was obtained in 68.7% of distal, in 33.3% of intermediate, and in 10% of proximal repairs. Average outcomes were good, insufficient, and poor, respectively ( P < .001). Nerve defect and preoperative interval were both significantly shorter on average for patients with successful outcome than for those with unsuccessful outcome ( P < .001 and P = .007, respectively), but only preoperative interval and height of repair were independent predictors for successful outcome. Age of patient, associated ulnar nerve complete lesion, and manner of repair did not influence the outcome significantly ( P > .05). Conclusions The level of repair, duration of preoperative interval, and length of nerve defect significantly influence outcome after median nerve repair, but only level of repair and duration of preoperative interval were independent predictors for successful outcome.