Nerve injuries sustained during warfare: part I--Epidemiology

Area of Science:

• Orthopedics
• Neurology
• Trauma Surgery

Background:

• Peripheral nerve injuries (PNI) are a significant concern in military conflicts.
• Understanding the patterns and outcomes of war-related PNIs is crucial for effective treatment.

Purpose of the Study:

• To detail the characteristics of 261 peripheral nerve injuries in 100 consecutive service members injured in Iraq and Afghanistan.
• To analyze the types, distribution, associated injuries, and outcomes, including neuropathic pain, of these war-related nerve lesions.

Main Methods:

• Retrospective review of 100 consecutive service members with 261 peripheral nerve injuries.
• Classification of nerve lesions (neurapraxia, axonotmesis, neurotmesis) and analysis of injury mechanisms, limb distribution, and associated trauma.
• Assessment of follow-up data including surgical interventions, tissue loss, and development of neuropathic pain.

Main Results:

• The majority of injuries were neurapraxia (45%) and axonotmesis (35%), evenly affecting upper and lower limbs.
• Explosions (63%) were the primary cause, with 82% of injuries associated with open wounds. Ulnar, common peroneal, and tibial nerves were most frequently affected.
• Associated injuries included vascular damage or fractures in 69 patients, major tissue loss in 50, and amputation in 18. Severe neuropathic pain affected 36 patients.

Conclusions:

• War-related peripheral nerve injuries present with diverse patterns, often linked to explosions and open wounds.
• A significant proportion of patients experience associated injuries, tissue loss, and develop chronic neuropathic pain, necessitating comprehensive management strategies.
• This study provides valuable insights into the epidemiology and clinical features of combat-related PNIs, informing future treatment and rehabilitation efforts.