Management of Adult Traumatic Brachial Plexus Injury

Area of Science:

• Orthopaedic Surgery
• Neurosurgery
• Traumatology

Background:

• Brachial plexus injuries cause significant upper limb disability, often resulting from motor vehicle accidents.
• Effective surgical treatment is crucial for restoring function and improving quality of life in affected adults.

Purpose of the Study:

• To evaluate the outcomes of various surgical reconstructive procedures for adult traumatic brachial plexus injuries.
• To identify factors influencing functional recovery, focusing on shoulder, elbow, and hand function.

Main Methods:

• A prospective study of 105 adult patients with traumatic brachial plexus injuries treated surgically between January 2012 and July 2019.
• Surgical options included neurolysis, nerve repair, nerve grafts, nerve transfers (neurotization), and free functioning muscle transfer.
• Patients were categorized by injury pattern (upper, extended upper, global brachial plexus) and followed for 6 months to 6 years.

Main Results:

• Satisfactory shoulder abduction and external rotation, and elbow flexion were achieved in upper and extended upper brachial plexus injuries.
• Global brachial plexus injuries showed acceptable, comparable recovery of shoulder abduction and elbow flexion.
• Hand function recovery was poor across all injury types, even with free functioning muscle transfer.

Conclusions:

• Surgical reconstruction offers functional benefits for shoulder and elbow in traumatic brachial plexus injuries.
• Nerve transfer techniques are effective for upper and extended upper plexus injuries.
• Restoring hand function remains a significant challenge in adult traumatic brachial plexus injuries.