Journal Article

Evaluation of traumatic peripheral nerve injuries in terms of Forensic Medicine/Travmatik periferik sinir yaralanmalarinin Adli Tip acisindan degerlendirilmesi

Bulutluoz, Emre Gurkan, Balandiz, Huseyin, Ozsoy, Sait

2025

Overview

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 6,953 cases who presented to the Forensic Medicine Clinic of Gulhane Training and Research Hospital between September 1, 2016 and June 31, 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: This study analyzed 393 cases with ages ranging from 17 to 70 years (mean age: 28.2 years). Of these, 94.9% were security personnel. The most common causes of injury were explosive devices and firearm injuries. The most frequently damaged nerves were the peroneal, ulnar, and tibial nerves. According to EMG findings, partial axonal degeneration was detected in 82.79% of the injured nerves, while total axonal degeneration was identified in 17.21%. Injuries were most commonly observed in the elbow-forearm region. Full functional recovery was noted in 5.1% of the cases. Bone fractures, particularly in the knee-leg region, were present in 73.3% of the cases. Psychiatric disorders developed in 22.1% of the cases. Injuries were deemed permanent in 94.5% of the cases, and re-evaluation was required in 60.7% of the cases after 18 months post-injury. Permanent disability was identified in 94.9% of the cases. CONCLUSION: A detailed forensic evaluation of traumatic peripheral nerve injuries was conducted, highlighting their frequent occurrence in military conflict zones. A meticulous assessment of symptoms resulting from these injuries is necessary. Electromyography findings are effective in evaluating nerve injuries and should be integrated with physical examinations. Keywords: Forensic medicine; nervous system; trauma. AMAC: Travmatik periferik sinir yaralanmalari, genc yaslarda engellilige yol acan baslica nedenlerden biridir. Bu calismada, travmatik nedenlerle periferik sinir yaralanmasi gelisen olgularin adli tibbi acidan degerlendirilmesi ve karakteristik ozelliklerinin ortaya konmasi amaclanmistir. GEREC VE YONTEM: Gulhane Egitim ve Arastirma Hastanesi Adli Tip poliklinigine 01.09.2016-31.06.2023 tarihleri arasinda basvuran 6953 olgu retrospektif olarak incelenmis ve travmatik periferik sinir yaralanmasi olan 393 olgu calismaya dahil edilmistir. Olgularin yasi, cinsiyeti, meslegi, travma nedeni, dava kapsami, yaralanan periferik sinirler, eslik eden kemik kirigi, kas gucu ve duyusal kayip, fonksiyonel iyilesme durumu, psikiyatrik tani ve elektromiyografi (EMG) sonuclari incelenmistir. Tum olgularin tibbi raporlari ilgili yasal mevzuatlar kapsaminda degerlendirilmistir. BULGULAR: Calismada yaslari 17-70 arasinda degisen 393 vaka (ort. 28.2 yas) incelenmistir. Olgularin %94.9'u guvenlik personelidir. En sik yaralanma nedenleri patlayici madde ve atesli silah yaralanmalaridir. Peroneal, ulnar ve tibial sinirler en sik hasar goren sinirlerdir. EMG bulgularina gore, yaralanan sinirlerin %82.79'unda parsiyel, %17.21'inde total aksonal dejenerasyon saptanmistir. Yaralanmalar en sik dirsek-on kol bolgesinde meydana gelmistir. Olgularin %5.1'inde fonksiyonel tam iyilesme gozlenmistir. %73.3'unde kemik kiriklari, ozellikle diz-bacak bolgesinde saptanmistir. %22.1'inde psikiyatrik bozukluk gelismistir. Yaralanmalarin %94.5'i araz niteligindedir ve %60.7'sinde yaralanmanin uzerinden 18 ay gectikten sonra muayene gerekmektedir. %94.9'unda engel orani olusturacak sekel tespit edilmistir. SONUC: Travmatik periferik sinir yaralanmalarinin adli tip acisindan detayli degerlendirilmesi yapilmis, bu yaralanmalarla askeri catisma bolgelerinde sikca karsilasildigi gosterilmistir. Yaralanmalar sonucunda olusan semptomlarinin dikkatli incelenmesi gereklidir. EMG bulgulari, sinir yaralanmalarinin degerlendirilmesinde etkili olup, fizik muayene ile birlikte degerlendirilmelidir. Anahtar sozcukler: Adli tip; travma; sinir sistemi.

• Publisher: KARE Publishing
• Subject: Analysis / Injuries / Mental illness / Security guards