Brachial plexus injury management in military casualties: who, what, when, why, and how

• Published in: Military medicine Vol. 179; no. 6; pp. 640 - 644
• Main Authors: Chambers, James A, Hiles, Claire L, Keene, Brian P
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.06.2014
• Subjects: Algorithms; Anniversaries; Armor; Brachial plexus; Brachial Plexus - injuries; History, 20th Century; History, 21st Century; History, Ancient; Injuries; Military Personnel; Mortality; Neck; Nerve Transfer; Orthopedics; Peripheral Nerve Injuries - diagnosis; Peripheral Nerve Injuries - history; Peripheral Nerve Injuries - surgery; Surgeons; Tendon Transfer; Time; Trauma; United States; World War II; United States; United States > US; Iraq
• ISSN: 0026-4075; 1930-613X
• DOI: 10.7205/MILMED-D-13-00457

The Global War on Terrorism has achieved an unprecedented 90% casualty survival rate because of far forward surgical support, rapid transport, and body armor. Despite the remarkable protection body armor affords, peripheral nerve injuries continue to occur. The brachial plexus in particular is still susceptible to penetrating trauma through the axilla as well as blunt mechanisms. We report 1,818 individuals with reported cases of peripheral nerve injury, 97 of which had brachial plexus injury incident from Operation Iraqi Freedom and Operation Enduring Freedom. We suspect that true prevalence is higher as initial focus on vascular and orthopedic reconstruction in complex shoulder injuries may overlook brachial plexus lesions. Accordingly, emergency physicians, general and orthopedic trauma surgeons, and vascular surgeons should all consider the possibility of brachial plexus and other peripheral nerve injury for early and appropriate referral to surgeons (plastic, orthopedic, or neurosurgical) for further evaluation and reconstruction. The latter group should be familiar with appropriate modern diagnostic and initial as well as salvage therapeutic options.