THE EP IDEMIOLOGY AND MANAGEMENT OF UPPER L IMB PERIPHERAL NERVE IN JURIES IN MODERN PRACTICE

This paper reports an epidemiological and clinical study of 813 patients with 1,111 peripheral nerve injuries who were treated for upper limb trauma, which included nerve injury, at two plastic surgery units in south-east England, predominantly between the years 1982 and 1991. The frequency distributions of the levels of nerve injury, and the causes of nerve injury in the sample, are presented, together with the surgical management and timing of nerve repair in these patients. 1,018 clinically suspected nerve injuries in 730 patients (91.6 % of nerves, 89.8 % of patients) were treated by primary nerve repair, elective delayed nerve repair or primary surgical exploration alone. Divisions of 93 nerves in 83 patients (8.3 % of nerves, 10.2 % of patients) were treated other than by primary repair or elective delayed repair, due to delayed referral from accident and emergency departments, resulting from missed or uncertain diagnosis at presentation or otherwise unaccounted elay in the initial referral. Journal of Hand Surgery (British and European Volume, 1996) 2lB. " 1:4 13 Currently there is a deficiency of accurate information about the aetiology and pattern of nerve injuries in patients with upper limb trauma who are referred to units for hand surgery in the United Kingdom. Additionally, there is little information about the pro-portion of such patients who are not referred for special-ist attention from accident and emergency departments at presentation, about the subsequent management of these nerve injuries. In order to address these questions we have undertaken a study of the clinical case notes of two samples of patients treated for nerve injury eithe