The Pattern of Peripheral Nerve Injuries among Iraqi Soldiers in the War by using Nerve Conductive Study


Background: Traumatic war injury of peripheral nerves is a worldwide problem and can result in significant disability. Management of peripheral nerve injuries (PNIs) requires accurate localization and the assessment of severity of the nerve lesion. Objective: To assess the electrophysiological pattern of peripheral nerve injuries among Iraqi soldiers in the war and compare it with the experience elsewhere. Patients and Methods: A case series study was carried out in the Department of Electrodiagnosis of Al-Yarmok Teaching Hospital for a period from December 2015 to July 2016. Two groups of human subjects included in the present study: Control group consists of (50) healthy volunteers and the patients group consists of (136) with documented war peripheral nerve injuries (Iraqi soldiers) were included in this study, their age ranging from (20 years) till( 49years). Physical examination and electrodiagnostic study was carried with interventions both of the nerve conductive study (NCS) and the needle electromyographic study (EMG). The main parameters which were used in the study for the sensory nerves (distal sensory latency, amplitude, sensory nerve conduction velocity). For the motor nerves (distal motor latency, nerve conduction velocity, F-wave, latency, amplitude, decay, temporal dispersion). Needle EMG study (spontaneous activity, motor unit potential, recruitment and interference pattern). Results: There were (136) cases of war peripheral nerve injuries. The improvised explosive device (IEDs) was the main cause of the peripheral nerve injuries (PNIs) in (66%) of the cases followed by gunshot in (28%) of cases and (6%) of cases had (PNIs) secondary to fall from explosion , burial under debris and motor vehicle accidents. Most commonly injured nerves was sciatic (28%) followed by common peroneal nerve (22%), tibial nerve (11%), ulnar nerve (9%), femoral nerve (8%), median nerve (6%), radial nerve (6%), brachial plexus (4%) , lumbosacral plexus (4%), musculocutaneous nerve (1%) and axillary nerve (1%) respectively. Conclusion: PNIs are a major component of war related injuries mainly involving upper and lower limbs. Electrodiagnostic studies in help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extended rehabilitation services.