Lower Extremity Combat Sustained Peripheral Nerve Injury in US Military Personnel

Abstract

Background: Since the civil war, combat sustained peripheral nerve injuries (CSPNI) have been documented during wartime. Warfare has evolved and current combat involves a greater severity of blast injuries secondary to increased use of improvised explosive devices. The purpose of this study was to describe CSPNI and report outcomes after evaluation and treatment. We hypothesize that a shorter time to evaluation will improve outcomes. Methods: A database including all active duty service members who sustained a CSPNI and were treated by the PNC between 2004 and 2009 was used. Service member demographic information, injury mechanism, CSPNI description, and Medical Research Council (MRC) final motor and sensory outcomes were queried from this database. Results: One hundred and four military service members sustained 144 PNIs. The average age was 26.7 years, and nearly all were men (98.1%). There was no correlation between Sunderland classification and age, specific PNI, injury type, or time to evaluation. Higher Sunderland classifications were found to be correlated with worse final motor (r = 0.51, P < 0.001) and final sensory (r = 0.41, P < 0.001) scores. Final motor and sensory scores were not associated with specific nerve injury, mechanism of injury, initial EMG, or surgical procedure. Shorter time to initial assessment was associated with improved final motor and sensory scores, but was not found to be statistically significant. Conclusions: As the complexity of CSPNIs progress as combat weaponry evolves, a firm understanding of treatment factors is important. Our study demonstrates in recent conflict that military service members’ initial injury severity is a key factor in expected outcome.

Functional reconstruction of lower extremity nerve injuries

“…Isolated injuries of the tibial nerve are rare, with traumatic and iatrogenic injuries occurring 2-3× less frequently than CPN injuries [2,5,42] . However, the motor and sensory deficit associated with tibial nerve injury can be very morbid.…”

“…Peripheral nerve injuries (PNI) in the lower extremity are an uncommon but highly morbid condition, usually resulting from traumatic or iatrogenic injury. In the civilian trauma setting, PNIs occur in 1.8%-2.8% of extremity injuries, of which 23%-40% are of the lower extremity [1,2] . Injuries to the peroneal and sciatic nerves are the most common, accounting for more than two-thirds of cases.…”

A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel

“…39 Modern advances in battlefield medicine and trauma resuscitation have led to the emergence of a group of unexpected survivors who would have previously succumbed to their wounds but now live with the consequences of these injuries. 50 The anatomical disruption caused by blast or penetrating injury can cause trauma to the nervous system 22 and may give rise to neuropathic pain at almost any body location. 45 Pain following amputation has been described in the context of military trauma for more than 500 years, with Ambroise Pare (1510-1590), a French military surgeon, identifying patients who reported pain in the missing limb after traumatic amputation.…”

“…The anatomical disruption caused by blast or penetrating injury can cause trauma to the nervous system 22 and may give rise to neuropathic pain at almost any body location. 45 Pain following amputation has been described in the context of military trauma for more than 500 years, with Ambroise Pare (1510-1590), a French military surgeon, identifying patients who reported pain in the missing limb after traumatic amputation.…”