Combat-Sustained Peripheral Nerve Injuries in the United States Military
| Autor: | Leon J. Nesti, Jason M. Souza, John C. Dunn, William W. Campbell, Matthew E. Miller, Jonathan K. Smith, Mark E. Landau, Michael D. Eckhoff, Kimbra Kenney, Tyler C. Nicholson |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Warfare Active duty Referral Traumatic brain injury Sensory system 030230 surgery 03 medical and health sciences 0302 clinical medicine Peripheral nerve Blast Injuries Peripheral Nerve Injuries Medicine Humans Orthopedics and Sports Medicine Peripheral Nerves Retrospective Studies 030222 orthopedics business.industry Evidence-based medicine medicine.disease United States Military Personnel Peripheral nerve injury Physical therapy Surgery Electronic database business |
| Zdroj: | The Journal of hand surgery. 46(2) |
| ISSN: | 1531-6564 |
| Popis: | 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 ( Conclusions Service members with more severe initial injuries had worse final outcomes. Although timely referral does not occur for most CSPNIs, a shorter time to presentation also led to improved sensory recovery. Complex combat-sustained PNIs may be best understood and treated within a multidisciplinary team. Type of study/level of evidence Prognostic IV. |
| Databáze: | OpenAIRE |
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