The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Neurosurgery

Background:

• High-energy extremity trauma often involves complex skeletal and soft tissue injuries.
• Concomitant peripheral nerve injuries can be overlooked in polytraumatized patients.
• Previous literature reports <10% incidence of nerve injuries in high-energy trauma.

Purpose of the Study:

• To determine the incidence of upper extremity peripheral nerve injuries in combat-related limb salvage.
• To assess the pain sequelae and functional outcomes associated with these nerve injuries.
• To evaluate the management strategies for nerve injuries in this specific patient population.

Main Methods:

• Retrospective review of patients undergoing limb salvage with flap coverage for combat-related upper extremity trauma (Jan 2011-Jan 2020).
• Data collected included demographics, perioperative complications, nerve injury location, surgical interventions, chronic pain, and functional limitations.
• Analysis focused on the incidence and outcomes of peripheral nerve injuries.

Main Results:

• 67% of 49 upper extremities (33/49) in 45 patients sustained nerve injuries.
• The ulnar nerve was most commonly injured (51%), followed by median (30%) and radial/posterior interosseous (19%).
• 55% of injured extremities (18/33) underwent surgical intervention, primarily nerve repair/reconstruction (67%) or targeted muscle reinnervation (TMR, 17%).

Conclusions:

• Upper extremity peripheral nerve injuries are highly prevalent in combat-related limb salvage.
• These injuries frequently result in chronic pain and functional limitations.
• Surgeons should anticipate and be prepared to manage nerve injuries during limb salvage procedures.