POSSIBILITIES OF ULTRASONIC DIAGNOSTICS IN ASSESMENT OF STRUCTURAL CHANGES OF PERIPHERAL NERVES IN AMPUTATED LIMBS IN CASE OF GUNSHOT INJURY

 

Gumerova E.A.¹, Dubrovskih S.N.¹, Tatarina A.V.¹, Stepanova Y.A.²

 

1 - National medical research center for high medical technologies, A.A. Vishnevsky Central military clinical hospital. Krasnogorsk, Russia.

2 - A.V. Vishnevsky National Medical Research Center for Surgery. Moscow, Russia.

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urpose. To identify the capabilities of the ultrasound in assessing structural changes in the terminal parts of peripheral nerves and identifying terminal neuromas after limb amputation in case of gunshot injury.

Materials and methods. We have examined 86 patients with amputations of the upper and lower limbs at various levels, and with amputation of a finger, who were treated in the FSBI “A.A. Vishnevsky NMRC for HMT" of the Ministry of Defense of Russian Federation during the period from March, 2022 to September, 2024. All injured are men aged from 20 to 57 years. Amputations were caused by a gunshot injury (GI). Ultrasound examination of the peripheral nerves of the amputated limbs was performed for all patients using a standard technique and a linear sensor 7-17 MHz in B-mode and using a color Doppler mapping (CDM). The examination was performed due to pain of various intensity in the stump. The total number of nerves examined to assess structural changes is 219, 181 of them were proximal ends. The prescription period of GI ranged from 11 to 405 days, of surgical intervention – from 3 to 355 days. During the scanning there was assessed the anatomical integrity of the peripheral nerve with the determination of the cross-sectional area (CSA), its contours, echostructure, the existence of terminal neuromas (TN) with the determination of their CSA and alien bodies (metal fragments) in soft tissues, presence of involvement of the proximal nerve end in the cicatrix, the existence of hematomas and other pathological formations in the soft tissues of the stump.

Results. The condition of the ends of peripheral nerves on limbs amputated due to GI was assessed, with identification of three main groups of structural changes (n=181): the 1st group (n=110, 61%) consisted of structural changes without reliable signs of TN; the 2nd group (n=45, 25%) consisted of structural changes with TN; the 3rd group (n=26, 14%) consisted of structural changes with the "potential" (emerging) TN. The frequency of occurrence of each group and the relationship with the level of amputation were determined, and the timing of TN detection was defined.

There have been identified pathological changes that cause pain leading to a perceptible decrease in patients’ quality of life and impeding earlier prosthetics and restoration of limb function. The effectiveness of the ultrasound diagnostics for this category of patients has been demonstrated.

Discussion. In contrast to injuries of peripheral nerves in everyday life, TN detected after amputations due to GI was accompanied by structural changes in the proximal end of the nerve in 100% of cases. Results of this research correlate with the data in related scientific articles, and as a result the positive relationship between the prescription period of the injury and the CSA of TN was confirmed.

It has also been confirmed that the CSA of the TN is 2 or more times higher than the CSA of the proximal end of the nerve. The presence of metal fragments in the bodies of patients from this group prevents performing magnetic resonance imaging (MRI) and makes ultrasound the main method in the diagnostics of this pathology with many advantages such as non-invasiveness of the method, lack of radiation exposure, and the possibility of an unlimited number of examinations over time.

Conclusion. Ultrasound examination is an effective method for identifying TN which can be a potential cause of pain experienced by the patients after amputation of a limb after a GI. For diagnostics of TN in the peripheral nerves ends of amputated limbs, ultrasound should be performed no earlier than 31 days after surgery.

The echographic criteria of a TN subject to surgical intervention (excision) are: a formed TN with CSA exceeding the CSA of the nerve’s end for 2 or more times, a pronounced local soreness during sensor compression in the area of the identified TN.=

 

Keywords: peripheral nerve ultrasound, terminal neuroma, peripheral nerve injury, gunshot injury.

 

Corresponding author: Gumerova E.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Gumerova E.A., Dubrovskih S.N., Tatarina A.V., Stepanova Y.A. Possibilities of ultrasonic diagnostics in assesment of structural changes of peripheral nerves in amputated limbs in case of gunshot injury. REJR 2025; 15(1):150-166. DOI: 10.21569/2222-7415-2025-15-1-150-166.

Received:        16.12.24 Accepted:       03.03.25