Peripheral nerve injuries: an international survey of current treatments and future perspectives.

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Abstract

[Indexed for MEDLINE] 9. J Hand Surg Am. 2021 Feb;46(2):148.e1-148.e8. doi: 10.1016/j.jhsa.2020.08.004. Epub 2020 Oct 2. Combat-Sustained Peripheral Nerve Injuries in the United States Military. Dunn JC(1), Eckhoff MD(2), Nicholson TC(1), Campbell W(3), Kenney K(4), Smith J(3), Landau M(3), Miller M(5), Souza J(4), Nesti LJ(6). Author information: (1)Department of Orthopaedics, William Beaumont Army Medical Center, El Paso, TX. (2)Department of Orthopaedics, William Beaumont Army Medical Center, El Paso, TX. Electronic address: michael.d.eckhoff@gmail.com. (3)Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD. (4)Department of Plastic Surgery, Walter Reed National Military Medical Center, Bethesda, MD. (5)Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD. (6)Clinical and Experimental Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. PURPOSE: Combat-sustained peripheral nerve injuries (CSPNIs) are often the result of high-energy blast mechanisms and are increasing in frequency and severity among US forces engaged in contemporary warfare. The purpose of this study was to describe CSPNIs and report outcomes after evaluation in a military multidisciplinary peripheral nerve clinic. We hypothesized that a shorter time to evaluation by a multidisciplinary peripheral nerve team would improve outcomes. METHODS: The Peripheral Nerve Consortium (PNC) maintains an electronic database of all active duty service members who sustained a peripheral nerve injury (PNI) and were treated by the PNC between 2004 and 2009. This database was queried for service member demographic information, injury characteristics, wounding patterns, CSPNI description, surgical procedures, and Medical Research Council final motor and sensory outcome. RESULTS: Among the 104 service members treated by the PNC in the 6-year period reviewed, there were 138 PNIs. Average age was 27 years, time to initial evaluation by the PNC was 4 (±7) months, and average follow-up was 18 (±18) months. Associated injuries included fractures (31.1%), multiple PNIs (76.8%), vascular injury (30.4%), and traumatic brain injury (34.1%). There was no association between Sunderland classification and time to evaluation, mechanism of injury, or nerve injured. However, Sunderland classification was correlated with final motor and final sensory scores. Service members with better final sensory score (S1 or S2) had shorter time to initial evaluation than did patients with a final sensory score of S0 (