Article

Nerve injuries sustained during warfare: part II: Outcomes.

War Nerve Injury Clinic, Headley Court, Epsom, Surrey KT18 6JW, UK. .
The Bone & Joint Journal (Impact Factor: 2.8). 04/2012; 94(4):529-35. DOI: 10.1302/0301-620X.94B4.28488
Source: PubMed

ABSTRACT The outcomes of 261 nerve injuries in 100 patients were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in 18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)). The initial grades for the 42 sutures and graft were 11 good, 14 fair and 17 poor. After subsequent revision repairs in seven, neurolyses in 11 and free vascularised fasciocutaneous flaps in 11, the final grades were 15 good, 18 fair and nine poor. Pain was relieved in 30 of 36 patients by nerve repair, revision of repair or neurolysis, and flaps when indicated. The difference in outcome between penetrating missile wounds and those caused by explosions was not statistically significant; in the latter group the onset of recovery from focal conduction block was delayed (mean 4.7 months (2.5 to 10.2) vs 3.8 months (0.6 to 6); p = 0.0001). A total of 42 patients (47 lower limbs) presented with an insensate foot. By final review (mean 27.4 months (20 to 36)) plantar sensation was good in 26 limbs (55%), fair in 16 (34%) and poor in five (11%). Nine patients returned to full military duties, 18 to restricted duties, 30 to sedentary work, and 43 were discharged from military service. Effective rehabilitation must be early, integrated and vigorous. The responsible surgeons must be firmly embedded in the process, at times exerting leadership.

0 Bookmarks
 · 
118 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Median nerve injuries in the forearm are reasonably common and can lead to devastating functional sequelae for the hand if they are not managed in a timely and appropriate fashion. Most nerve lacerations should be repaired soon after injury, and current widespread application of microsurgical techniques should lead to reasonable results in most individuals. Despite these advances, many patients do not have ideal outcomes from injuries to the median nerve and are often left with permanent sequelae. This article will discuss current techniques in the management of median nerve injuries, with the goal of preventing or alleviating the potential negative sequelae of these injuries.
    The Journal Of Hand Surgery 06/2014; 39(6):1216–1222. DOI:10.1016/j.jhsa.2014.01.025 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: When is common peroneal nerve repair worthwhile? What is the effect of delayed repair? What is the maximum length of graft that can be used? This study aimed to address these questions by assessing the current literature and ascertaining the predictors of outcome that would guide peripheral nerve surgeons in determining the correct treatment of common peroneal nerve injury.
    Plastic &amp Reconstructive Surgery 08/2014; 134(2):302e-11e. DOI:10.1097/PRS.0000000000000318 · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy, is attracting more public attention in Japan which is likely a result of the recent upsurge in lawsuits filed against medical institutes. A recent court ruling over a case of injection-needlestick-injury induced CRPS has touched off serious debates among both medical practitioners and legal professionals. Although the court rejected the plaintiff's claims, the high court admitted them in view of the evidence and the entire pleadings and ordered the defendant to pay compensation. As venipuncture is the most frequently conducted and minimally invasive procedure in daily clinical practice, this court decision has attracted tremendous interest throughout the nation, alarming medical practitioners, and encouraging attorneys. The purpose of this article is twofold: to highlight the patient's clinical course in summary based on an unofficial case law report(1) and to provide a scientific perspective on this issue based on recent relevant articles.
    Hand Surgery 01/2014; 19(2):151-62. DOI:10.1142/S0218810414400012

Full-text

Download
68 Downloads
Available from
May 31, 2014