Nerve injuries sustained during warfare

Abstract

We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.

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

“…The incidence of causalgia, the most severe of neuropathic pain states, was approximately 5%, similar to that reported in modern conflict 48 49. Platt48 reported excellent results with resection and suture of the affected nerves, abolishing pain in 9/12 patients.…”

Pain‐related psychological distress, self‐rated health and significance of neuropathic pain in Danish soldiers injured in Afghanistan

“…The age of the sample was 26 (24)(25)(26)(27)(28)(29)(30)(31) years. The majority of the participants were married or living with a partner, had completed at least an upper secondary education programme and were employed.…”

“…Furthermore, 21% had neuropathic pain (PainDETECT scores ≥ 19), whereas 51% had mainly nociceptive pain (PainDETECT scores ≤ 12). The Post-traumatic Stress Disorder Checklist-Civilian score was 26 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31), the anxiety score was 4 (2-6.5) and the score for depression was 2 (1-5).…”

Pain Management in Military Trauma

“…17 This is a particularly important finding, as nerve injuries are a significant trauma finding in battlefield injuries, with prolonged conduction block/neuropraxia, axonotmesis, and neurotmesis being outcomes of explosive injury. 18 Interventional analgesia, as part of an acute pain management service trialed in Afghanistan, used trigger point injections, as well as the use of regional nerve blocks and epidural analgesia, as a means to decrease pain intensity, to provide increased pain relief, and to avoid the adverse effects associated with opioid therapy. 19 This may prove particularly beneficial in the management of postamputation pain, where phantom limb sensations were more effectively treated with early regional blockade.…”