Postdoctoral Research Fellow University of Louisville Louisville, KY, US
Introduction: Modern warfare has introduced unique patterns of peripheral nerve injuries (PNIs) as military technologies evolve. Up to 30% of wartime injuries now involve peripheral nerves, often from direct trauma or shockwaves. While some PNIs resolve spontaneously, the majority require surgical intervention, highlighting a need for continuous improvement in treatment approaches.
Methods: A systematic review, meta-analysis, and bibliometric analysis were conducted to assess wartime PNI patterns and treatment advancements from 1980 to 2024. Searches were carried out in PubMed, Embase, Scopus, and Web of Science using terms like “Peripheral Nerve Injuries,” “war,” “recovery,” and “treatment modalities.” Inclusion criteria focused on peer-reviewed studies with data on PNI characteristics, treatments, and outcomes in military and civilian populations. Data extraction captured PNI characteristics, injury settings, and treatment types. Bibliometric analysis utilized co-citation, keyword mapping, and trend analyses to reveal key thematic shifts over time. Comparative analyses were conducted using t-tests and ANOVA, and random effect models calculated odds ratios (OR) and pooled prevalence with 95% confidence intervals (CI).
Results: Ninety-seven studies met inclusion criteria, primarily documenting PNIs in conflicts such as the Yugoslavian wars, Iraq and Afghanistan conflicts, and the Syrian civil war. Advanced bibliometric analyses identified shifts in research focus, revealing increased emphasis on PNIs associated with improvised explosive devices (IEDs) and severe injury types like neurotmesis and axonotmesis (P=0.01). From 2001 to 2020, innovations like nerve transfers and allografts became prominent, reflecting adaptations in surgical approaches for complex war-related injuries. Meta-analytic findings showed nerve grafting to be significantly more effective than direct repair in PNI recovery (OR = 3.79, 95% CI: 2.08–6.94, P=0.0001).
Conclusion : This study illustrates evolving patterns in wartime PNI, with advanced bibliometric analysis providing insights into thematic and methodological shifts across decades. The findings underscore the need for cutting-edge surgical interventions, including nerve transfers and allografts, to address the increasing complexity of modern PNIs. These advancements highlight the necessity for adaptive strategies in PNI management to improve recovery outcomes for injured service members in military settings.
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