DOI QR코드

DOI QR Code

Traumatic peripheral nerve injuries in young Korean soldiers: a recent 10-year retrospective study

  • Chul Jung (Department of Rehabilitation Medicine, Armed Forces Capital Hospital) ;
  • Jae-hyun Yun (Department of Rehabilitation Medicine, Armed Forces Capital Hospital) ;
  • Eun Jin Kim (Department of Rehabilitation Medicine, Armed Forces Capital Hospital) ;
  • Jaechan Park (Department of Rehabilitation Medicine, Armed Forces Capital Hospital) ;
  • Jiwoon Yeom (Department of Rehabilitation Medicine, Armed Forces Capital Hospital) ;
  • Kyoung-Eun Kim (Department of Rehabilitation Medicine, Armed Forces Capital Hospital)
  • Received : 2024.01.03
  • Accepted : 2024.07.01
  • Published : 2024.09.30

Abstract

Purpose: Traumatic peripheral nerve injury (PNI), which occurs in up to 3% of trauma patients, is a devastating condition that often leads to permanent disability. However, knowledge of traumatic PNI is limited. We describe epidemiology and clinical characteristics of traumatic PNI in Korea and identify the predictors of traumatic complete PNI. Methods: A list of enlisted soldier patients who were discharged from military service due to PNI over a 10-year period (2012-2021) was obtained, and their medical records were reviewed. Patients were classified according to the causative events (traumatic vs. nontraumatic) and injury severity (complete vs. incomplete). Of traumatic PNIs, we compared the clinical variables between the incomplete and complete PNI groups and identified predictors of complete PNI. Results: Of the 119 young male patients who were discharged from military service due to PNI, 85 (71.4%) were injured by a traumatic event; among them, 22 (25.9%) were assessed as having a complete injury. The most common PNI mechanism (n=49, 57.6%), was adjacent fractures or dislocations. Several injury-related characteristics were significantly associated with complete PNI: laceration or gunshot wound, PNI involving the median nerve, PNI involving multiple individual nerves (multiple PNI), and concomitant muscular or vascular injuries. After adjusting for other possible predictors, multiple PNI was identified as a significant predictor of a complete PNI (odds ratio, 3.583; P=0.017). Conclusions: In this study, we analyzed the characteristics of enlisted Korean soldiers discharged due to traumatic PNI and found that the most common injury mechanism was adjacent fracture or dislocation (57.6%). Patients with multiple PNI had a significantly increased risk of complete injury. The results of this study contribute to a better understanding of traumatic PNI, which directly leads to a decline in functioning in patients with trauma.

Keywords

Acknowledgement

This work was supported by the Korean Military Medical Research Project (No. ROK-MND-2022-KMMRP-001), funded by the Korean Ministry of National Defense.

References

  1. Wojtkiewicz DM, Saunders J, Domeshek L, Novak CB, Kaskutas V, Mackinnon SE. Social impact of peripheral nerve injuries. Hand (N Y) 2015;10:161-7. 
  2. Miller C, Peek AL, Power D, Heneghan NR. Psychological consequences of traumatic upper limb peripheral nerve injury: a systematic review. Hand Ther 2017;22:35-45. 
  3. Bruyns CN, Jaquet JB, Schreuders TA, Kalmijn S, Kuypers PD, Hovius SE. Predictors for return to work in patients with median and ulnar nerve injuries. J Hand Surg Am 2003;28:28-34. 
  4. Bergmeister KD, Grosse-Hartlage L, Daeschler SC, et al. Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity. PLoS One 2020;15:e0229530. 
  5. Huckhagel T, Nuchtern J, Regelsberger J, Gelderblom M, Lefering R; TraumaRegister DGU®. Nerve trauma of the lower extremity: evaluation of 60,422 leg injured patients from the TraumaRegister DGU® between 2002 and 2015. Scand J Trauma Resusc Emerg Med 2018;26:40. 
  6. Huckhagel T, Nuchtern J, Regelsberger J, Lefering R; TraumaRegister DGU. Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015. Scand J Trauma Resusc Emerg Med 2018;26:76. 
  7. Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 1998;45:116-22. 
  8. Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve 2022;66:661-70. 
  9. Dunn JC, Eckhoff MD, Nicholson TC, et al. Combat-sustained peripheral nerve injuries in the United States military. J Hand Surg Am 2021;46:148. 
  10. Eckhoff MD, Craft MR, Nicholson TC, Nesti LJ, Dunn JC. Lower extremity combat sustained peripheral nerve injury in US military personnel. Plast Reconstr Surg Glob Open 2021;9:e3447. 
  11. Yegiyants S, Dayicioglu D, Kardashian G, Panthaki ZJ. Traumatic peripheral nerve injury: a wartime review. J Craniofac Surg 2010;21:998-1001. 
  12. Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol 2008;119:1951-65. 
  13. Miranda GE, Torres RY. Epidemiology of traumatic peripheral nerve injuries evaluated with electrodiagnostic studies in a tertiary care hospital clinic. P R Health Sci J 2016;35:76-80. 
  14. Babaei-Ghazani A, Eftekharsadat B, Samadirad B, Mamaghany V, Abdollahian S. Traumatic lower extremity and lumbosacral peripheral nerve injuries in adults: electrodiagnostic studies and patients symptoms. J Forensic Leg Med 2017;52:89-92. 
  15. Ciaramitaro P, Mondelli M, Logullo F, et al. Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients. J Peripher Nerv Syst 2010;15:120-7. 
  16. Rivera JC, Glebus GP, Cho MS. Disability following combat-sustained nerve injury of the upper limb. Bone Joint J 2014;96-B:254-8. 
  17. Kouyoumdjian JA, Graca CR, Ferreira VF. Peripheral nerve injuries: a retrospective survey of 1124 cases. Neurol India 2017;65:551-5. 
  18. Eser F, Aktekin LA, Bodur H, Atan C. Etiological factors of traumatic peripheral nerve injuries. Neurol India 2009;57:434-7. 
  19. Razaq S, Yasmeen R, Butt AW, Akhtar N, Mansoor SN. The pattern of peripheral nerve injuries among Pakistani soldiers in the war against terror. J Coll Physicians Surg Pak 2015;25:363-6. 
  20. Jones PE, Meyer RM, Faillace WJ, et al. Combat injury of the sciatic nerve: an institutional experience. Mil Med 2018;183:e434-41. 
  21. Solmaz I, Cetinalp EN, Gocmez C, et al. Management outcome of peroneal nerve injury at knee level: experience of a single military institution. Neurol Neurochir Pol 2011;45:461-6. 
  22. Brininger TL, Antczak A, Breland HL. Upper extremity injuries in the U.S. military during peacetime years and wartime years. J Hand Ther 2008;21:115-22. 
  23. Wang E, Inaba K, Byerly S, et al. Optimal timing for repair of peripheral nerve injuries. J Trauma Acute Care Surg 2017;83:875-81. 
  24. Beltran MJ, Burns TC, Eckel TT, et al. Fate of combat nerve injury. J Orthop Trauma 2012;26:e198-203. 
  25. Simske NM, Krebs JC, Heimke IM, Scarcella NR, Vallier HA. Nerve injury with acetabulum fractures: incidence and factors affecting recovery. J Orthop Trauma 2019;33:628-34. 
  26. Kim KE, Kim EJ, Park J, Kim SW, Kwon J, Moon G. Humeral shaft fracture and radial nerve palsy in Korean soldiers: focus on arm wrestling related injury. BMJ Mil Health 2021;167:80-3. 
  27. Robinson LR. Predicting recovery from peripheral nerve trauma. Phys Med Rehabil Clin N Am 2018;29:721-33. 
  28. Houdek MT, Shin AY. Management and complications of traumatic peripheral nerve injuries. Hand Clin 2015;31:151-63. 
  29. Modrak M, Talukder MA, Gurgenashvili K, Noble M, Elfar JC. Peripheral nerve injury and myelination: potential therapeutic strategies. J Neurosci Res 2020;98:780-95.