Complex peripheral nerve injuries

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


  • Reduce fractures/dislocations urgently if there is an associated nerve injury.
  • Refer the following for plastics opinion:
    • Laceration near a nerve.
    • Laceration associated with a neurological deficit.


  • 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 to wait for the scan.


  • 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 nerve.
    • If not oppose nerve with fine coloured sutures and 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.
    • Refer consultant if no improvement to 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.