Frequency of occurrence. Since the XX century. gunshot wounds of nerve trunks of limbs begin to occur more often than in past wars. According to German statistics, injuries of nerve trunks in the First World War amounted to 1.5-4% of all injuries, according to American data -2%, according to French – 1.2%. During the fighting near Lake Hassan, nerve injuries accounted for 3% of all injuries. Damage to peripheral nerves during gunshot fractures of the limb bones occurs in 15-20% of victims.
Closed nerve damage in combat is less common (1.6% of cases according to the materials of the Great Patriotic War). Both with wounds and with closed injuries, partial or complete disruption of the continuity (integrity) of nerve trunks can occur.
Classification of damage to nerve trunks
Damage to the peripheral nerves can occur both with open (more often) and with closed injuries. Open damage – cut, lacerated, chopped, gunshot wounds. Both with wounds and with bruises, a partial or complete violation of the continuity or integrity of the nerve trunks is possible.
Morphological changes in the nerves after their damage: 1) a complete anatomical break; 2) partial break; 3) a nerve injury. With a complete anatomical break, the ends of the nerve trunk diverge by a certain distance and shift in the lateral directions. At the proximal end of the nerve, as a rule, a neuroma is formed. In the peripheral segment, bundles of nerve fibers degenerate, and the end of the nerve turns into a scar. With a partial anatomical break, a part of the nerve trunk ruptures. In the area of the gap , a neuroma, scars are formed. With a bruise in the nerve trunk, most of the connective tissue membranes are preserved, hemorrhages occur in them, tears. Intra- beam and intra- barrel neuromas form . The nerve trunk at the level of the contusion is usually thickened, uneven and dense. Thus, the trauma disrupts the basic structure of the nerve, primarily due to the formation of scar tissue in the membranes and neuroma of various sizes and locations. With a complete anatomical break in the nerve trunk, nerve conduction is completely disrupted, and with a partial anatomical break in the nerve trunk, movements of part of the muscles or sensitivity in the corresponding zones can be preserved.