Missile Injury of Peripheral Nerves

Abstract

ABSTRACT
Background: Missile injuries to the peripheral nerves present a specific problem
regarding their clinical and morphological characteristics, indications, timing of surgery
and prognosis.
Objectives: To evaluate the benefit of surgical intervention and factors that improves
surgical out com in those patients with missile injury of peripheral nerve.
Methods: This retrospective study conducted in Al-Fallujah teaching hospital between
Sept 2009 and August 2013. We were studying 50 patients presented with missile injury to
the peripheral nerves involving the sciatic, peroneal, median, ulnar and radial nerves. The
patients’ age ranged from 20-40 years with male to female ratio of 5:1. The most common
nerve injured in this study was the sciatic nerve and the least one was the common
peroneal nerve.
Results: In this study, 26(52%) patients were injured by bullet and 24(48%) patients by
shell injury, 7(14%) patients treated conservatively and 43(86%) patients by surgery, as
34(68%) patients were treated by neurolysis and 9(21%) patients by direct end to end
anastomosis. Twenty six patients (52%) had good to fair functional recovery and 24
patients (48%) had poor surgical outcome after follow up period of 3 months-2 years. The
best functional recovery (good and fair) was for median nerve, as from 12 patients injured,
6 (50%) patients had fair prognosis, 4 (33.3%) patients had good prognosis and 2(16%)
patients had bad prognosis. Seven patients with radial nerve injury, 4(57%) patients had
good prognosis, 2(28.5%) patients had fair prognosis and one (14%) patient had bad
prognosis. For 8 patients with ulnar nerve injury, 3(37.5%) patients had bad prognosis,
2(25%) patients had fair prognosis and 3(33.5%) patients had good prognosis. For 20
patients of sciatic nerve injury, 13(65%) patients had bad prognosis, 4(20%) patients had
fair prognosis, and 3(15%) patients had good prognosis. For common peroneal nerve
injury we have only 3 patients 2(66.6%) had fair prognosis and one (33.3%) had bad
prognosis.
Conclusion: The best functional recovery was for median, radial, taking into
consideration that 4 radial nerve injuries did not give us precise results. And the worst
prognosis was for sciatic nerve injury, where 13(65%) of 20 patients with sciatic nerve
injury had bad prognosis. Most cases of functional recovery related to young age group
and treated within 6 months of injury, while those of bad result related to those older then
40 years and delayed after 6 months.