Peripheral Nerve Injury in Modern Warfare

Neal J. Naff, MD
Jeffrey M. Tomlin, MD (Bethesda, MD)

Introduction:

The spectrum of peripheral nerve injury in the major wars of this century has been reported previously. Improved body armor and lower scale conflict may make those reports less applicable to modern warfare. This report analyzes the scope of peripheral nerve injury occurring in post–Vietnam conflicts.

Methods:

An extensive literature search identified reports of wartime nerve injury since 1980. Reports delineating the location and agent of injury were selected for analysis. To accurately assess distribution of injury, reports limited to specific nerves were excluded.

Results:

113 reports of wartime nerve injuries were identified; 7 fulfilled the criteria for further analysis. The reports were from Iran/Iraq (1), Afghanistan(l), Persian Gulf(l), and Balkan(4) wars. 4,213 nerve injuries were identified. Agents of injury were low–velocity missiles (64%, n=2696); high–velocity missiles(20%, n=843); and blunt force(16%, n=674). The distribution of injured nerves in decreasing order was: median (22%, n=927), ulnar (21%, n=885), Radial (18%, n=758), peroneal (18%, n=758), sciatic (8%, n=336), femoral (4%, n=l68), brachial plexus (4%, n=l68), lumbar plexus (3%, n=126), musculocutaneous (2%, n=84), other(O%, n=3). Associated bone fractures occurred in 38%(n=l601); vascular injury in 37% (n=l559).

Conclusion:

Peripheral nerve injury in modern warfare results most frequently from low velocity missiles, endangers a wide distribution of nerves, and is often associated with bone fractures and vascular injuries. The care of nerve injured combatants requires broad anatomical knowledge and multispecialty skills.