title: Brachial plexus injury management in military casualties: who, what, when, why, and how.
abstract: 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.
authors.affiliation: Office of the Air Force Surgeon General, AFMSA/SG3XI, 7700 Arlington Boulevard, Suite 5156, Falls Church, VA 22042.
authors.forename: James A
authors.initials: JA
authors.lastname: Chambers
authors.affiliation: Department of Internal Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Hiles
authors.affiliation: Landstuhl Regional Medical Center, MEDCOM ERMC, Building 20, RM 51, Landstuhl/Kirchberg, Germany, 66849.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Keene
mesh_terms: D000465:Algorithms; D001917:Brachial Plexus / Q000293:injuries*; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D008889:Military Personnel; D016067:Nerve Transfer; D059348:Peripheral Nerve Injuries / Q000175:diagnosis* / Q000266:history / Q000601:surgery*; D013709:Tendon Transfer; D013995:Time; D014481:United States