Ultrasound as the main method for diagnosing peripheral nerve injuries in mine blast trauma

Abstract

BACKGROUND: The amount of published data related to peripheral nerve blast injuries is limited.
 AIM: The study was aimed at determining the accuracy and sensitivity and assessing the specificity of ultrasound in the diagnosis of peripheral nerve injuries in mine blast trauma.
 METHODS: A total of 159 patients (274 peripheral nerves) were examined. Ultrasound was performed according to the standard technique using a HI VISION Avius HITACHI scanner with an EUP-L74M linear transducer (a frequency range of 513 MHz) and a preset musculoskeletal system ultrasound program. The duration of nerve injuries ranged from 2 to 273 days. All patients were men aged 20 to 48 years. Peripheral nerves were damaged as a result of mine blast trauma. Statistical analysis was used to assess sensitivity, specificity, and diagnostic accuracy. These characteristics were calculated according to the qualitative assessment of surgical intervention, the results of conservative treatment, and the method under study (ultrasound).
 RESULTS: A total of 274 damaged peripheral nerves were examined. The Group 1 included 93 (34%) nerves that required surgical intervention. In Group 2, consisting of 181 (66%) nerves, conservative treatment was used. Most of the nerves (47 [51%]) in Group 1 were damaged due to the compression effects of scarring in the surrounding tissues. Seventeen (18%) partial violations of the anatomical integrity of nerves with the formation of intramural and marginal neuromas were detected. Multiple and single nerve injuries were observed in 95 (59.7%) and 64 people (40.3%), respectively. Peripheral nerves of the upper extremities were damaged more frequently (185 [67.5%]), whereas nerves of the lower extremities were damaged in 89 (32.5%) cases. Ultrasound showed an increase in the cross-sectional area of nerves, blurred contours, decreased echogenicity, and changes in the bundle structure up to the complete absence of differentiation of individual fascioculi. The formation of neuromas was observed in complete and partial nerve ruptures. All 93 nerves in Group 1 underwent surgical intervention, particularly, external neurolysis (32 [34%]), internal neurolysis (15 [16%]), nerve suture (15 [16%]), excision of neuroma followed by microsurgical epineural suture (18 [19%]), and autoneural plasty (11 [12%]). In 2 (3%) cases, a decision was made to abstain from plasty and perform a tendon transposition due to a pronounced diastasis. All patients of Group 2 were shown to have a wait-and-see approach, and conservative therapy was prescribed. In 179 (99%) cases, complete recovery of sensory and motor activity was observed within 21 days. In 2 (1%) patients, a repeated ultrasound was performed due to no effect of treatment. Compression by scar tissues was revealed, and surgical intervention was made.
 CONCLUSIONS: In mine-explosive impact, ultrasound is the leading method for diagnosing peripheral nerve injuries. Ultrasound with sensitivity of 97.8% and specificity of 98.8% reveals lesions for which surgical treatment is indicated. The diagnostic accuracy is 98.5%.