Timing of surgical intervention in peripheral nerve injuries from gunshot wounds: Management and review of the literature

Abstract

Background: Gunshot wounds (GSWs) can result in various peripheral nerve injuries (PNIs), ranging from direct nerve transection to neuropraxia caused by the ballistic shockwave mechanism. PNIs from GSWs can be treated with either early or delayed intervention, with the literature supporting both approaches and sparking a debate between early and delayed intervention for PNIs from GSWs. Here, we present a case that underwent delayed exploration of the right common peroneal nerve after GSW and a literature review comparing early versus delayed intervention for PNIs from GSWs. Case Description: A 29-year-old male underwent right common peroneal nerve exploration 2 months after he sustained a GSW to the right lower extremity at the level of the fibular head tracking to the lateral malleolus. Initially, after the injury, he was offered supportive care. On evaluation, 1 month later, he reported a right-sided foot drop and paresthesias in the right lower extremity. A partial-thickness injury of the right peroneal nerve was seen on ultrasound, and a bullet fragment in the distal right lower extremity was revealed on computed tomography. The surgical intervention consisted of the right common peroneal nerve decompression proximally to distally and removal of the bullet fragment. Postoperatively, the patient did well with improvements in his right ankle dorsiflexion and plantar flexion seen at his 1.5-month follow-up visit. Conclusion: Many factors must be considered when treating PNIs from GSWs. For each case, clinical judgment, injury mechanism, and risk-benefit analysis must be evaluated to determine each patient’s optimal treatment strategy.