Incidence Of Peripheral Nerve Injury Research Articles

Risk Factors for Peripheral Nerve Injury Following Revision Total Hip Arthroplasty in 112,310 Patients.

Background: Peripheral nerve injury (PNI) following revision total hip arthroplasty (rTHA) can be a devastating complication. This study assessed the frequency of and risk factors for postoperative PNI following rTHA. Methods: Patients who underwent rTHA from 2003 to 2015 were identified using the National Inpatient Sample (NIS). Demographics, medical history, surgical details, and complications were compared between patients who sustained a PNI and those who did not, to identify risk factors for the development of PNI after rTHA. Results: Overall, 112,310 patients who underwent rTHA were identified, 929 (0.83%) of whom sustained a PNI. Univariate analysis found that younger patients (p < 0.0001), females (p = 0.025), and those with a history of flexion contracture (0.65% vs. 0.22%, p = 0.005), hip dislocation (24.0% vs. 18.0%, p < 0.001), and spine conditions (4.8% vs. 2.7%, p < 0.001) had significantly higher rates of PNI. In-hospital complications associated with PNI included postoperative hematoma (2.6% vs. 1.2%, p < 0.0001), postoperative seroma (0.75% vs. 0.30%, p = 0.011), superficial wound dehiscence (0.65% vs. 0.23%, p = 0.008), and postoperative anemia (36.1% vs. 32.0%, p = 0.007). Multivariate analysis demonstrated that a history of pre-existing spine conditions (aOR: 1.7; 95%-CI: 1.3-2.4, p < 0.001), prior dislocation (aOR 1.5; 95%-CI: 1.3-1.7, p < 0.001), postoperative anemia (aOR 1.2; 95%-CI: 1.0-1.4, p = 0.01), and hematoma (aOR 2.1; 95%-CI: 1.4-3.2, p < 0.001) were associated with increased risk for PNI. Conclusions: Our findings align with the existing literature, affirming that sciatic nerve injury is the prevailing neuropathic complication after total hip arthroplasty (THA). Furthermore, we observed a 0.83% incidence of PNI following rTHA and identified pre-existing spine conditions, prior hip dislocation, postoperative anemia, or hematoma as risk factors. Orthopedic surgeons may use this information to guide their discussion of PNI following rTHA, especially in high-risk patients.

NPD1 Relieves Neuropathic Pain and Accelerates the Recovery of Motor Function After Peripheral Nerve Injury.

The incidence of peripheral nerve injury (PNI) in China is continuously increasing. With an inability to function due to sensory and motor abnormalities, patients with PNI suffer from neuropathic pain and subsequent lesions. Presently, effective treatments for PNI are limited. To determine the role of neuroprotectin D1 (NPD1) in PNI, a sciatic nerve crush injury model was developed to investigate the impact of NPD1 on sensory and motor function recovery following nerve injury. The results demonstrated that NPD1 administered at different time points might reduce mechanical allodynia and thermal hyperalgesia caused by PNI, and its analgesic effect was not tolerated. Immunohistochemistry analyses revealed that administering NPD1 to PNI mice decreased the spinal microglia and astrocyte activation and decreased the inflammatory factor expression in the spinal dorsal horn. Furthermore, NPD1 can inhibit the invasion of IBA-1+ macrophages in dorsal root ganglions generated by nerve injury. Meanwhile, it can help rehabilitate motor and neuromuscular functions following PNI. The results indicate that NPD1 may be involved in the sensory and motor function recovery following PNI.

Multifunctional wet-adhesive chitosan/acrylic conduit for sutureless repair of peripheral nerve injuries

The incidence of peripheral nerve injury (PNI) is high worldwide, and a poor prognosis is common. Surgical closure and repair of the affected area are crucial to ensure the effective treatment of peripheral nerve injuries. Despite being the standard treatment approach, reliance on sutures to seal the severed nerve ends introduces several limitations and restrictions. This technique is intricate and time-consuming, and the application of threading and punctate sutures may lead to tissue damage and heightened tension concentrations, thus increasing the risk of fixation failure and local inflammation. This study aimed to develop easily implantable chitosan-based peripheral nerve repair conduits that combine acrylic acid and cleavable N-hydroxysuccinimide to reduce nerve damage during repair. In ex vivo tissue adhesion tests, the conduit achieved maximal interfacial toughness of 705 J m−2 ± 30 J m−2, allowing continuous bridging of the severed nerve ends. Adhesive repair significantly reduces local inflammation caused by conventional sutures, and the positive charge of chitosan disrupts the bacterial cell wall and reduces implant-related infections. This promises to open new avenues for sutureless nerve repair and reliable medical implants.

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later. This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors. A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses. Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position. The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.

Epidemiology of upper extremity peripheral nerve injury in South Korea, 2008 to 2018

Peripheral nerve injuries (PNIs) in the upper extremities is an important medical problem, causing significant morbidity at a relatively young age. The epidemiology of PNI in South Korea has not been comprehensively evaluated. The purpose of our study was to examine the incidence of upper extremity PNI in South Korea based on an analysis of nationwide data and to investigate the association between PNI and patients' demographic characteristics. Patient claims data from the Health Insurance Review and Assessment Service from 2008 to 2018 were collected. Demographic characteristics, such as the age, sex, region, admission route, length of hospital stay, healthcare facility level, and cost were evaluated. Annual incidence, body sites affected, damaged nerves, accompanying injuries, and surgical procedures were analyzed. Annual incidence trends, injured anatomical area, seasonal injury trends, and injury trend according to sex were also evaluated. A total of 57,209 cases were identified during the study period. Mean age was 39.7 ± 16.3 years. Of these cases, 51,651 (90.28%) were surgically treated. About 79% of accompanying injuries occurred in the hand area (hand lacerations, 69.5%; fractures or joint dislocations of the hands, 6.86%; crushing injuries of the hands, 2.67%). Overall, injuries to the digital nerve showed the greatest frequency (62.7%). In the upper arm and forearm, the ulnar nerve was most frequently injured; however, in the hand, radial nerve injuries were most common. The annual incidence rate per 100,000 persons decreased from 10.67 in 2008 to 7.88 in 2018. The annual incidence decreased by 0.98 times per year. PNI occurred 33.91 times more frequently in the finger than in the upper arm, and there were 1.16 times more PNIs in the summer and 2.14 times more in men. We investigated the incidence trend and epidemiologic characteristics of upper extremity peripheral nerve injury in South Korea from 2008 to 2018. A decreasing tendency of annual incidence was observed from 2013 onwards. Finger and digital nerve were most commonly injured, and the incidence of PNI was higher in the summer and in men.

Peroneal nerve injuries during anterior ankle arthroscopy

Objective: Ankle arthroscopic surgery is considered a safe procedure with minimal risk of peripheral nerve injury. The primary objective of this study was to determine the incidence of peripheral nerve injuries during anterior ankle arthroscopy. The secondary objective was to evaluate the most frequent types and the clinical relevance of deep peroneal nerve injuries. Methods: Patients who underwent anterior ankle arthroscopy at our institution from 2000 to 2020 were retrospectively analyzed. Those present neurological symptoms after surgery were evaluated with clinical examination and ankle ultrasonography looking for nerve injuries. Results: Three hundred and thirty-four patients were included in the present study. There were 26 iatrogenic neurological complications (7.78%). The superficial peroneal nerve was injured in 16 cases (4.79%) and the deep peroneal nerve, in 10 cases (2.99%). Among the injuries of the deep peroneal nerve, 1.5% of cases had nerve entrapment in postoperative tissue adhesions, 0.9% presented neuromas, and 0.6% had axonotmesis. Complications were classified using the Modified Clavien-Dindo-Sink Complication Classification System: 2.1% of complications were grade I, while 0.9% were grade II. Conclusion: Nerve injury is the most common complication related to anterior ankle arthroscopy. The deep peroneal nerve is rarely damaged during this procedure. We found that most deep peroneal nerve injuries are not clinically relevant and do not have a big impact on patient evolution during the postoperative period. Level of Evidence II; Retrospective Study; Prognostic Studies.

Incidence of peripheral nerve injury in revision total shoulder arthroplasty: an intraoperative nerve monitoring study

The incidence of nerve injuries in revision total shoulder arthroplasty (TSA) is not well defined in the literature and may be higher than that in primary procedures, with 1 study reporting a complication rate of 50% for shoulder revisions. Given that continuous intraoperative nerve monitoring (IONM) can be an effective tool in diagnosing evolving neurologic dysfunction and preventing postoperative injuries, the purpose of this study was to report on IONM data and nerve injury rates in a series of revision TSAs. A retrospective cohort review of consecutive patients who underwent revision TSA was performed from January 2016 to March 2020. Indications for revision included infection (n = 7); failed total arthroplasty and hemiarthroplasty secondary to pain, dysfunction, and/or loose components (n = 36); and periprosthetic fracture (n = 1). Of the shoulders, 32 underwent revision to a reverse TSA, 6 underwent revision to an anatomic TSA, and 6 underwent spacer placement. IONM data included transcranial electrical motor evoked potentials (MEPs), somatosensory evoked potentials, and free-run electromyography. The motor alert threshold was set at ≥80% signal attenuation in any peripheral nerve. Patients were screened for neurologic deficits immediately following surgery, prior to administration of an interscalene nerve block, and during the first 2 postoperative visits. Additional data collection included surgical indication, sex, laterality, age at surgery, procedure performed, body mass index, history of tobacco use, Charlson Comorbidity Index, medical history, and preoperative range of motion. A total of 44 shoulders in 38 patients were included, with a mean age of 63.2 years (standard deviation, 13.0 years). Of the procedures, 22.4% (n = 10) had an MEP alert, with 8 isolated to a single nerve (7 axillary and 1 radial) and 1 isolated to the axillary and musculocutaneous nerves. Only 1 patient experienced a major brachial plexus alert involving axillary, musculocutaneous, radial, ulnar, and median nerve MEP alerts, as well as ulnar and median nerve somatosensory evoked potential alerts. Age, sex, body mass index, Charlson Comorbidity Index, and preoperative range of motion were not found to be significantly different between cases in which an MEP alert occurred and cases with no MEP alerts. In the postoperative period, no minor or major nerve injuries were found whereas distal peripheral neuropathy developed in 4 patients (9.1%). Among 44 surgical procedures, no patients (0%) had a major or minor nerve injury postoperatively and 4 patients (9.1%) complained of distal peripheral neuropathy postoperatively. In this study, we have shown that through the use of IONM, the rate of minor and major nerve injuries can be minimized in revision shoulder arthroplasty.

Incidence of peripheral nerve injury in oral maxillofacial surgery: a restrospective clinical study

Background: The most severe complication after the removal of mandibular third molars and implants placement in mandibular posterior region is the injury of inferior alveolar nerve. This complication is rather uncommon (0.4% to 8.4%) and most of it is transient. However, in some cases persist for longer than 6 months, which can leave various degrees of long-term permanent disability and is necessary a good the control of patients.

Incidence of peripheral nerve injury in oral maxillofacial surgery: a restrospective clinical study

Incidence of peripheral nerve injury in oral maxillofacial surgery: a restrospective clinical study

3D-Printed PCL/rGO Conductive Scaffolds for Peripheral Nerve Injury Repair.

The incidence of peripheral nerve injuries is on the rise and the current gold standard for treatment of such injuries is nerve autografting. Given the severe limitations of nerve autografts which include donor site morbidity and limited supply, neural guide conduits (NGCs) are considered as an effective alternative treatment. Conductivity is a desired property of an ideal NGC. Reduced graphene oxide (rGO) possesses several advantages in addition to its conductive nature such as high surface area to volume ratio due to its nanostructure and has been explored for its use in tissue engineering. However, most of the works reported are on traditional 2D culture with a layer of rGO coating, while the native tissue microenvironment is three-dimensional. In this study, PCL/rGO scaffolds are fabricated using electrohydrodynamic jet (EHD-jet) 3D printing method as a proof of concept study. Mechanical and material characterization of the printed PCL/rGO scaffolds and PCL scaffolds was done. The addition of rGO results in softer scaffolds which is favorable for neural differentiation. In vitro neural differentiation studies using PC12 cells were also performed. Cell proliferation was higher in the PCL/rGO scaffolds than the PCL scaffolds. Reverse transcription polymerase chain reaction and immunocytochemistry results reveal that PCL/rGO scaffolds support neural differentiation of PC12 cells.

Peripheral nerve injury arising in anaesthesia practice.

In this article, we will discuss the pathophysiology of peripheral nerve injury in anaesthetic practice, including factors which increase the susceptibility of nerves to damage. We will describe a practical and evidence-based approach to the management of suspected peripheral nerve injury and will go on to discuss major nerve injury patterns relating to intra-operative positioning and to peripheral nerve blockade. We will review the evidence surrounding particular strategies to reduce the incidence of peripheral nerve injury during nerve blockade, including nerve localisation methods, timing of blocks, needle techniques and design, injection pressure-monitoring and local anaesthetic and adjunct choice.

Incidence of peripheral nerve injury during shoulder arthroplasty when motor evoked potentials are monitored.

To report the incidence of clinically detectable nerve injuries when utilizing transcranial electrical motor evoked potentials (MEPs) during shoulder arthroplasty. A retrospective review of patients undergoing shoulder arthroplasty with continuous IONM was performed. The criteria for nerve alerts was an 80% amplitude reduction in MEPs. The primary outcome measure was post-operative clinically detectable nerve deficit. An additional retrospective analysis on a subset of cases using an all-or-none (100% amplitude reduction) criterion applied to the deltoid was performed. Two hundred eighty four arthroplasty cases were included. There were no permanent post-operative nerve injuries and two transient nerve injuries (0.7%). MEP alerts occurred in 102 cases (36.2%). Nineteen (6.7%) cases did not have signals return above alert threshold at closure. These cases were significantly associated with post-operative nerve injury (p = 0.03). There were no false negatives, making sensitivity 100% and specificity was 93.9%. In the subset of cases in which an all-or-none criterion was retrospectively applied to just the deltoid, MEP alerts occurred in just 17.9% of cases; specificity improved to 98.0%. We conclude that utilization of the real-time diagnostic MEP data during shoulder arthroplasty aids surgeons in decision making regarding impending peripheral nerve injuries.

Neurosurgical position causes peripheral nerve injuries?

Abstract Background Positioning during neurosurgical procedures is a challenge for surgical teams even if precautions are taken, the mechanisms underlying peripheral nerve injury (elongation, compression or ischaemia) are latent and it is important to know the frequency of occurrence in our environment. Objective To analyse the frequency of peripheral nerve injury secondary to surgical positioning. Materials and methods Prospective study including 163 patients scheduled for neurosurgical procedures. Four groups: supine, lateral, ventral and park bench were analysed by neurological exploration in order to detect injury and relate with risk factors already described. Results In this study 112 patients were included, two patients who were under park bench position experienced paresthesias in ulnar region of less than 24 hours’ duration; statistically significant correlation with body weight greater than 85 kg. Conclusion The incidence of peripheral nerve injury is low, understanding the mechanisms that may originate it helps towards prevention and early detection of complications.

Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery

Study ObjectiveTo compare the amount of patient displacement when a memory foam pad is used versus a bean bag with shoulder braces. The secondary aim was to evaluate for postoperative extremity symptoms including pain, numbness, and weakness. DesignA prospective randomized pilot study (Canadian Task Force classification I). SettingA single academic institution. PatientsWomen ≥18 years of age undergoing laparoscopic or robotic gynecologic surgery. InterventionsPatients were randomized to be positioned on the memory foam pad (group A) or the bean bag with shoulder braces (group B) preoperatively. The patients' positions were measured before and after the procedure, and the displacement was recorded. Patients were followed postoperatively and questioned regarding upper extremity or lower extremity weakness, numbness, and pain. Demographic characteristics were collected using the electronic medical record. Measurements and Main ResultsForty-three patients were included in the study (22 in group A and 21 in group B). The demographic and intraoperative characteristics of the patients were similar in both groups. The patients in group A moved a mean distance of 3.80 ± 3.32 cm, whereas those in group B moved a mean distance of 1.07 ± 1.93 cm (p = .002). A Pearson correlation coefficient did not yield a correlation between patient displacement and age, body mass index, length of surgery, or pathology weight. In group A, 2 patients had lower extremity numbness, and 1 patient had upper extremity numbness. In group B, 1 patient had upper extremity pain, and 1 patient had both upper and lower extremity numbness. These patients had complete resolution of their symptoms within the first 2 weeks postoperatively, with the exception of 1 patient in group A whose lower extremity numbness resolved 3 months postoperatively. ConclusionPositioning patients on the bean bag with shoulder braces resulted in significantly less displacement during gynecologic laparoscopic surgery when compared with the memory foam pad. All postoperative extremity numbness, weakness, and pain were temporary and resolved completely in our cohort. A larger study would be necessary to determine the true incidence of peripheral nerve injuries because these are rare complications of laparoscopic surgeries.

The Prevention and Recognition of Ulnar Nerve and Brachial Plexus Injuries

Perioperative peripheral nerve injury is a serious yet preventable perioperative complication. Since the inception of the American Association of Anesthesiologists Closed Claim Project, the incidence of peripheral nerve injury has remained constant with an overall reported prevalence rate of 15% to 16%. To date, the most frequent nerve injuries are ulnar nerve neuropathy and brachial plexus injury. This article will review the clinical presentation, pathophysiology, causative and risks factors, and preventive measures for the two most common nerve injuries. Knowledge of the anatomical structures and components of peripheral nerves prone to injuries during surgery can assist in defining precautionary actions in the perioperative setting. Positioning techniques in the operating room, early recognition of neuropathies, and use of a perioperative tool in the postoperative setting are keys to reduce significant clinical complications.

¿La posición neuroquirúrgica ocasiona lesión de nervio periférico?

BackgroundPositioning during neurosurgical procedures is a challenge for surgical teams even if precautions are taken, the mechanisms underlying peripheral nerve injury (elongation, compression or ischaemia) are latent and it is important to know the frequency of occurrence in our environment. ObjectiveTo analyze the frequency of peripheral nerve injury secondary to surgical positioning. Materials and methodsProspective study including 163 patients scheduled for neurosurgical procedures. Four groups: supine, lateral, ventral and park bench were analyzed by neurological exploration in order to detect injury and relate with risk factors already described. ResultsIn this study 112 patients were included, two patients who were under park bench position experienced paresthesias in ulnar region of less than 24 hours’ duration; statistically significant correlation with body weight greater than 85kg. ConclusionThe incidence of peripheral nerve injury is low, understanding the mechanisms that may originate it helps towards prevention and early detection of complications.

The Incidence of Peripheral Nerve Injury After Multimodal Perineural Anesthesia/Analgesia Does Not Appear to Differ from That Following Single-Drug Nerve Blocks (2011-2014).

Recently, we reported on the in vitro [1] and in vivo [2] animal safety (rat) of four-drug nerve block (multimodal perineural anesthesia-analgesia, or MMPNA) combinations involving bupivacaine (BPV [2]), ropivacaine (RPV [1]), or midazolam (MDZ [1,2]) with the following three preservative-free injectable drugs: clonidine, buprenorphine, and dexamethasone [1,2] (hereafter abbreviated as CBD). In addition, we provided clinical benchmark data for patients having received nerve blocks with combined BPV-CBD [3] and MDZ-CBD [4]). The chronological time frame for these previous clinical benchmark reports [3,4] was July 2011 through March 2014. The current report covers intermediate and long-term peripheral nerve injury (PNI) outcomes for n = 1830 patient-block encounters dating from July 2011 through December 2014. We define a “patient-block encounter” as a uniquely identified patient encounter receiving one or more nerve blocks on a specific day for pre- and intra-operative anesthesia/analgesia, immediate postoperative analgesia, or rescue postoperative analgesia on a day after surgery, typically during the same hospital stay. The blocks used for these 1830 patient-block encounters were composed primarily of BPV-CBD (n = 1726; 94.3%), or MDZ-CBD (n = 104; 5.7%). Patients who were having surgery related to a current or previous surgical site infection typically did not have blocks that included perineural dexamethasone (n = 109/1830, or 6%). The objective of this report is to present complication-related quality improvement (QI) data from our institution in the epidemiologic context of such data published elsewhere regarding the risk of PNI complications related to surgery itself (without specific nerve block considerations) or specifically related to nerve blocks typically using local anesthetics only (in the absence of multiple or any perineural adjuvants). In our institution (Veterans Affairs Pittsburgh Healthcare System, VAPHS), the lead author was charged with …

Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis.

Since the original 2010 publication of this analysis, evidence has continued to support the concept that ultrasound (US) guidance does not meaningfully affect the incidence of peripheral nerve injury (PNI) associated with regional anesthesia. Similar confirmatory evidence attests to US guidance reducing the incidence and intensity of hemidiaphragmatic paresis (HDP) but not eliminating it. Literature published since late 2009 reports the effective role of US guidance in reducing the incidence of local anesthetic systemic toxicity and allows calculation of a lower predicted frequency of pneumothorax associated with US-guided supraclavicular blocks.

Clinical Decision Support and Perioperative Peripheral Nerve Injury: A Quality Improvement Project.

Decision support at the point of care has been demonstrated to be an effective tool in providing a safe environment and improving patient outcomes. The operating room is typically an area where advanced technology is introduced to nurses on a regular basis. This quality improvement project focused on preventing a peripheral nerve injury, which is an example of a postoperative adverse event that is considered preventable. Injury of a peripheral nerve is the result of compression, hyperextension, flexion, or ischemia surrounding the nerve. The goals for this project were to improve the knowledge of peripheral nerve injury of the operating room nurses, design and implement a peripheral nerve injury assessment screen that could provide decision support within the operating room record, improve the nursing documentation of peripheral nerve injury interventions, and (long term) decrease the incidence of peripheral nerve injury. A decision support screen within the operating room record was designed to supplement the operating room nurse's risk assessment for peripheral nerve injury. The components of this project involved a preliminary and postproject surveys on peripheral nerve injury knowledge, an educational presentation, and a retrospective random review of nursing documentation in the operating room electronic health records. Project results demonstrated a significant increase in nursing documentation of peripheral nerve injury interventions (63%-92%) and a positive attitude toward their exposure to basic decision support (P = .046). Recommendations for future studies and establishing a standardized coding system for peripheral nerve injury identification were identified.

Falls and peripheral nerve injuries: an age-dependent relationship.

Despite the growing epidemic of falls, the true incidence of peripheral nerve injuries (PNIs) in this patient population remains largely unknown. The authors performed a retrospective cohort study of 839,210 fall-injured patients who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011 and fulfilled the inclusion criteria. Regression techniques were used to investigate the association of demographic and socioeconomic factors with the rate of PNIs in this patient population. The association of age with the incidence of PNIs was also investigated. Overall, 3151 fall-injured patients (mean age 39.1 years, 33.3% females) sustained a PNI (0.4% of all falls). The respective incidence of PNIs was 2.7 per 1000 patients for ground-level falls, 4.9 per 1000 patients for multilevel falls, and 4.5 per 1000 patients for falls involving force. This demonstrated a rapid increase in the first 2 decades of life, with a maximum rate of 1.1% of all falls in the 3rd decade, followed by a slower decline and eventual plateau in the 7th decade. In a multivariable analysis, the association of PNIs with age followed a similar pattern with patients 20-29 years of age, demonstrating the highest association (OR 2.34 [95% CI 2.0-2.74] in comparison with the first decade of life). Falls involving force (OR 1.25 [95% CI 1.14-1.37] in comparison with multilevel falls) were associated with a higher incidence of PNIs. On the contrary, female sex (OR 0.87 [95% CI 0.80-0.84]) and ground-level falls (OR 0.79 [95% CI 0.72-0.86]) were associated with a lower rate of PNIs. Utilizing a comprehensive national database, the authors demonstrated that PNIs are more common than previously described in fall-injured patients and identified their age distribution. These injuries are associated with young adults and falls of high kinetic energy.