Keywords
gunshot injury
electroneuromyography
sonography
upper limb
nerve injury
How to Cite
Abstract
Introduction. Firearm-related extremity injuries account for up to 60% of all combat-related trauma in modern warfare. Approximately one-third of these injuries are accompanied by fractures, while peripheral nerve damage of varying severity is diagnosed in about 40% of cases.
Objective. This study aims to characterize the patterns of combat-related peripheral nerve injuries sustained during modern military operations, with particular attention to the challenges of diagnosis and management across different stages of medical evacuation.
Materials and Methods. We analyzed the injuries of 163 male patients with firearm-related peripheral nerve damage of the upper limb. The mean age of the patients was 34±8.6 years. The diagnostic protocol included radiography, electroneuromyography, and ultrasonography of both the affected nerve and the muscles of the arm and forearm.
Results. Nearly 95% of patients sustained peripheral nerve injuries from fragmentation shells resulting from rocket–artillery and other remotely operated weapons. The majority of gunshot wounds were localized in the middle and distal third of the shoulder (42.3%), in the forearm (25.4%), and in the elbow joint area (14.9%). Among peripheral nerve injuries of the upper limb, radial nerve damage was most common (36.2%). Consequences of open fractures of the humerus were present in 45.1% of cases; fractures of the ulna and radius were associated with nerve injury in 19.8% and 17%, respectively.
Conclusions. Grade III–IV nerve injuries (according to Sunderland) occurred in 55.1% of patients, and complete anatomical nerve disruption was observed in 42.2% of cases. Nerve defects measuring 3–6 cm were recorded in 53 patients (56.7%) – this range is generally considered favorable for surgical reconstruction. In 9.6% of cases, nerve defects exceeded 12 cm. At earlier stages of medical evacuation, injured nerves were rarely repaired, and the diagnosis of such injuries was insufficient.
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