Evaluation of traumatic peripheral nerve injuries in terms of Forensic Medicine

Background: Traumatic peripheral nerve injuries are one of the leading causes of disability in young individuals. This study aims to evaluate cases of traumatic peripheral nerve injury from a forensic medical perspective and to identify their characteristic features.
Methods: A retrospective analysis was conducted on 6953 cases who presented to the Forensic Medicine Clinic of Gülhane Training and Research Hospital between 01.09.2016 and 31.06.2023. Among these, 393 cases with traumatic peripheral nerve injuries were included in the study. The age, gender, occupation, cause of trauma, scope of the legal case, injured peripheral nerves, associated bone fractures, muscle strength and sensory loss, functional recovery status, psychiatric diagnosis, and electromyography (EMG) results of the cases were examined. All medical reports of the cases were evaluated within the scope of relevant legal regulations.
Results: In this study, 393 cases with ages ranging from 17 to 70 years (mean age: 28.2 years) were examined. Of these, 94.9% were security personnel. The most common causes of injury were explosive devices and firearm injuries. The peroneal, ulnar, and tibial nerves were the most frequently damaged nerves. According to EMG findings, partial axonal degeneration was detected in 82.79% of the injured nerves, and total axonal degeneration in 17.21%. Injuries most commonly occurred in the elbow-forearm region. Functional full recovery was observed in 5.1% of the cases. Bone fractures, particularly in the knee-leg region, were detected in 73.3% of the cases. Psychiatric disorders developed in 22.1% of the cases. Injuries were of a permanent nature in 94.5% of the cases, and re-evaluation was required in 60.7% of the cases after 18 months post-injury. A permanent disability was identified in 94.9% of the cases.
Conclusion: A detailed forensic evaluation of traumatic peripheral nerve injuries was conducted, demonstrating the frequent occurrence of such injuries in military conflict zones. Careful examination of the symptoms resulting from these injuries is necessary. EMG findings are effective in the evaluation of nerve injuries and should be considered alongside physical examinations.

Travmatik periferik sinir yaralanmalarýnýn Adli Týp açýsýndan deðerlendirilmesi

Amaç: Travmatik periferik sinir yaralanmalarý, genç yaþlarda engelliliðe yol açan baþlýca nedenlerden biridir. Bu çalýþmada, travmatik nedenlerle periferik sinir yaralanmasý geliþen olgularýn adli týbbi açýdan deðerlendirilmesi ve karakteristik özelliklerinin ortaya konmasý amaçlanmýþtýr.
Gereç ve Yöntem: Gülhane Eðitim ve Araþtýrma Hastanesi Adli Týp polikliniðine 01.09.2016-31.06.2023 tarihleri arasýnda baþvuran 6953 olgu retrospektif olarak incelenmiþ ve travmatik periferik sinir yaralanmasý olan 393 olgu çalýþmaya dahil edilmiþtir. Olgularýn yaþý, cinsiyeti, mesleði, travma nedeni, dava kapsamý, yaralanan periferik sinirler, eþlik eden kemik kýrýðý, kas gücü ve duyusal kayýp, fonksiyonel iyileþme durumu, psikiyatrik taný ve elektromiyografi (EMG) sonuçlarý incelenmiþtir. Tüm olgularýn týbbi raporlarý ilgili yasal mevzuatlar kapsamýnda deðerlendirilmiþtir.
Bulgular: Çalýþmada yaþlarý 17-70 arasýnda deðiþen 393 vaka (ort. 28,2 yaþ) incelenmiþtir. Olgularýn %94,9’u güvenlik personelidir. En sýk yaralanma nedenleri patlayýcý madde ve ateþli silah yaralanmalarýdýr. Peroneal, ulnar ve tibial sinirler en sýk hasar gören sinirlerdir. EMG bulgularýna göre, yaralanan sinirlerin %82,79’unda parsiyel, %17,21’inde total aksonal dejenerasyon saptanmýþtýr. Yaralanmalar en sýk dirsek-ön kol bölgesinde meydana gelmiþtir. Olgularýn %5,1’inde fonksiyonel tam iyileþme gözlenmiþtir. %73,3’ünde kemik kýrýklarý, özellikle diz-bacak bölgesinde saptanmýþtýr. %22,1’inde psikiyatrik bozukluk geliþmiþtir. Yaralanmalarýn %94,5’i araz niteliðindedir ve %60,7’sinde yaralanmanýn üzerinden 18 ay geçtikten sonra muayene gerekmektedir. %94,9’unda engel oraný oluþturacak sekel tespit edilmiþtir.
Sonuç: Travmatik periferik sinir yaralanmalarýnýn adli týp açýsýndan detaylý deðerlendirilmesi yapýlmýþ, bu yaralanmalarla askeri çatýþma bölgelerinde sýkça karþýlaþýldýðý gösterilmiþtir. Yaralanmalar sonucunda oluþan semptomlarýnýn dikkatli incelenmesi gereklidir. EMG bulgularý, sinir yaralanmalarýnýn deðerlendirilmesinde etkili olup, fizik muayene ile birlikte deðerlendirilmelidir.