Management of the Mangled Extremity

Annotation for Point E

An adequate neurologic examination of the extremity to assess peripheral nerve function should be conducted. Nerve deficits, particularly tibial nerve, are thought to portend a dire functional outcome. Signs of specific nerve injuries are listed in Table 4. Prospective study,¹⁰ however, has demonstrated that peripheral nerve deficits are not sensitive predictors for failure of functional limb salvage. This finding may be reflective of the unpredictable natural course of many of these injuries. Differentiating neuropraxia, or temporary deficits, from permanent nerve injury in the acute phases after injury may prove difficult. It is important to document these findings, however, and factor their presence into the decisionmaking process.

Level of Supporting Evidence: Level 4