Background: A selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess\r\nand treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in\r\nwhich adjuvant investigations or interventions are not routinely performed, but based on physical examination only.\r\nMethods: All subsequent patients presented with PTE at a Dutch level I trauma center from October 2000 to June\r\n2011 were included in this study. In-hospital and long-term outcome was analysed in the light of assessment of these\r\npatients according to the SNOM protocol.\r\nResults: A total of 668 patients (88.2% male; 33.8% gunshot wounds) with PTE presented at the Emergency\r\nDepartment of a level 1 traumacenter, of whom 156 were admitted for surgical treatment or observation. Overall, 22\r\n(14%) patients that were admitted underwent exploration of the extremity for vascular injury. After conservative\r\nobservation, two (1.5%) patients needed an intervention to treat (late onset) vascular complications. Other long-term\r\nextremity related complications were loss of function or other deformity (n = 9) due to missed nerve injury, including 2\r\npatients with peroneal nerve injury caused by delayed compartment syndrome treatment.\r\nConclusion: A SNOM protocol for initial assessment and treatment of PTE is feasible and safe. Clinical examination of the\r\ninjured extremity is a reliable diagnostic ''tool'' for excluding vascular injury. Repeated assessments for nerve injuries are\r\nimportant as these are the ones that are frequently missed and result in long-term disability. Level of evidence: II / III,\r\nretrospective prognostic observational cohort study Key words Penetrating trauma, extremity, vascular injury, complications.
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