“Delayed Recovery” in Peripheral Nerve Lesions Caused by High Velocity Projectile Wounding

Abstract

I N DEALING wi th a large n u m b e r of p e r i p h e r a l n e r v e in jur ies due to w a r wounds , we h a v e been i m p r e s s e d wi th the n u m b e r of p a t i e n t s who rec o v e r func t ion s p o n t a n e o u s l y , a n d wi th t he s a t i s f a c t o r y degree of rec o v e r y t h a t m a n y of t h e m e v e n t u a l l y a t t a i n . E v e n in the cases t h a t h a v e been exp lo red wi th the e x p e c t a t i o n of f inding the n e r v e t r u n k c o m p l e t e l y severed , a su rp r i s ing ly large p e r c e n t a g e h a v e shown no d i s rup t i on of cont i n u i t y of the nerve . These o b s e r v a t i o n s seem to a p p l y less to t he ineis ional t y p e of w o u n d due to b a y o n e t s , kn ives a n d the like, b u t to be m o r e cha r ac te r i s t i c of t he w ounds due to h igh ve loc i t y project i les . I n o rde r to conf i rm ou r impress ions , we h a v e a n a l y z e d the h is tor ies of 154 m e n wi th lesions invo lv ing one or m o r e of t he t h r ee m a j o r ne rves to the hand , whose w o u n d s were due to project i les . I n 80 eases t he w o u n d i n g a g e n t was a bul le t , a n d in 75 in s t ances t he a g e n t was a me ta l l i c f r a g m e n t f r o m a shell, g renade , or mine , which has been cal led s h r a p n e l . One m a n sus t a ined s e p a r a t e bu l l e t wounds a f fec t ing m a j o r ne rves in each a r m , so t h a t the series compr i s e s 155 ease r epor t s . DESCRIPTION OF THE CASES The patients were all sailors or marines whose wounds were sustained in the Pacific theater of war. They reached our hospital on an average of three months from the time of wounding. In this interval they had received excellent care aboard ship or in the various landbased Hospital Units of the Navy, and in general their condition on reaching the mainland was excellent. The number of serious complications was remarkably low. Approximately one-third of these patients were transferred to other hospitals before our studies were completed, and a few additional have been received too recently to permit us to establish a definite prognosis as to spontaneous recovery. In 40 eases tile principal nerve injury implicated the radial nerve; in ~0, the median; and in 43, the ulnar. There were ~7 instances in which all three major nerves were simultaneously involved; 17 cases represented a combination of median and ulnar; 6, the radial and median; and ~, the radial and ulnar. In 5 cases the level of wounding was in the neck; ~9 were wounded in the axilla; 69 in the upper arm; 1~ in the region of the elbow; 36 in the forearm; and 4 were wounded at the wrist.