• Oscar J F Van Waes, Esther M M Van Lieshout, Wouter Hogendoorn, Jens A Halm, and Jefrey Vermeulen.
• Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, The Netherlands. o.vanwaes@erasmusmc.nl
• Scand J Trauma Resus. 2013 Jan 1;21:2.

BackgroundA selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess and treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in which adjuvant investigations or interventions are not routinely performed, but based on physical examination only.MethodsAll subsequent patients presented with PTE at a Dutch level I trauma center from October 2000 to June 2011 were included in this study. In-hospital and long-term outcome was analysed in the light of assessment of these patients according to the SNOM protocol.ResultsA total of 668 patients (88.2% male; 33.8% gunshot wounds) with PTE presented at the Emergency Department of a level 1 traumacenter, of whom 156 were admitted for surgical treatment or observation. Overall, 22 (14%) patients that were admitted underwent exploration of the extremity for vascular injury. After conservative observation, two (1.5%) patients needed an intervention to treat (late onset) vascular complications. Other long-term extremity related complications were loss of function or other deformity (n = 9) due to missed nerve injury, including 2 patients with peroneal nerve injury caused by delayed compartment syndrome treatment.ConclusionA SNOM protocol for initial assessment and treatment of PTE is feasible and safe. Clinical examination of the injured extremity is a reliable diagnostic 'tool' for excluding vascular injury. Repeated assessments for nerve injuries are important as these are the ones that are frequently missed and result in long-term disability.Level Of EvidenceII / III, retrospective prognostic observational cohort study Key words Penetrating trauma, extremity, vascular injury, complications.

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