Traumatic brachial plexus injuries: our experience on 485 surgical cases

Abstract

Traumatic injuries of the brachial plexus tend to, unfortunately, be quite frequent nowadays and often affect young adults. An increase in the number of traffic accidents, especially involving motorcycles, as well as, extreme sports accidents might be correlated to the increase of brachial plexus injuries. Although the research and statistical evidence on this topic is limited, the majority of our cases were involved in one of the two instances.

 Initially, the clinician has to make observations in regards to the location of the lesion, the severity of the trauma in order to deduce an expected clinical outcome. The information is accordingly obtained through a detailed history of the accident, a thorough physical examination, as well as, imaging studies and specialised electro-diagnostic and nerve conduction investigations.

Precision in the timing of the surgery, along with the surgeon’s knowledge and experience, as well as, the prioritisation of function restoration are of critical importance for the effectiveness of the treatment.

The surgical methods discussed in this article include the following: neurolysis, nerve repair with or without nerve grafts and nerve transfers for the restoration of the impaired functions of the upper limb. Based on our observations, it is important that the surgeon performing the operation is also the one deciding the recommendations for waiting and monitoring the injury.

This article will examine existing research on this subject but will mainly present the 485 cases the authors have treated over the last 25 years. Results will be analysed and discussed in order to present the factors influencing final recovery. It appears that time interval between injury and surgery, as well as, the number of roots involved in the trauma are most crucial.