Nerve injuries sustained during warfare

Abstract

The outcomes of 261 nerve injuries in 100 patients were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in 18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)). The initial grades for the 42 sutures and graft were 11 good, 14 fair and 17 poor. After subsequent revision repairs in seven, neurolyses in 11 and free vascularised fasciocutaneous flaps in 11, the final grades were 15 good, 18 fair and nine poor. Pain was relieved in 30 of 36 patients by nerve repair, revision of repair or neurolysis, and flaps when indicated. The difference in outcome between penetrating missile wounds and those caused by explosions was not statistically significant; in the latter group the onset of recovery from focal conduction block was delayed (mean 4.7 months (2.5 to 10.2) vs 3.8 months (0.6 to 6); p = 0.0001). A total of 42 patients (47 lower limbs) presented with an insensate foot. By final review (mean 27.4 months (20 to 36)) plantar sensation was good in 26 limbs (55%), fair in 16 (34%) and poor in five (11%). Nine patients returned to full military duties, 18 to restricted duties, 30 to sedentary work, and 43 were discharged from military service. Effective rehabilitation must be early, integrated and vigorous. The responsible surgeons must be firmly embedded in the process, at times exerting leadership.

Surgical advances during the First World War: the birth of modern orthopaedics

“…Delorme,42 in 1915, set out three principles for nerve repair: resection of scar until a healthy bed is secured, excision of damaged nerve until healthy stumps are reached and tension-free suture by adequate mobilisation and splinting the adjacent joints in flexion to maximise length. Using these principles the success rate (defined as improvement in motor/sensory function) was 62%, a figure comparable with surgical results reported in the current conflicts in Iraq and Afghanistan 38 43. Nerve grafting for larger defects almost universally gave poor results and were considered procedures of last resort 38…”

An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

“…The overall good outcomes (M4 or greater) across the 1577 repairs in 28 studies [1][2][3][4][5][6][7]10,[12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] amounted to slightly more than 45 percent. If studies from only the twenty-first century are taken into account, this percentage rises to slightly more than 50.2 percent (n = 1111); this is a significant improvement when compared with studies performed in the twentieth century, which was 38.7 percent (n = 466).…”

Ballistic Trauma: Lessons Learned from Iraq and Afghanistan

“…Concomitant nerve injuries are concerning and may have significant impact on functional status of the affected extremity. 35,41,42 Ballistic wounds increase the risk of nerve severance and irreparable damage. 43 Nerves can be repaired primarily or with autologous nerve grafts in situations where the nerves are deemed viable.…”