Nerve injuries sustained during warfare

Part I – Epidemiology

R. Birch, P. Misra, M. P. M. Stewart, W. G. P. Eardley, A. Ramasamy, K. Brown, R. Shenoy, P. Anand, J. Clasper, R. Dunn, J. Etherington


We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain.

This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.


  • No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Supplementary material. Two tables detailing the distribution, mechanism and nature of lesions in i) the upper and ii) the lower limb, and (iii) a further table recording pain syndromes in 36 patients, are available with the electronic version of this article on our website

  • Received October 19, 2011.
  • Accepted December 1, 2011.
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