Injury Patterns, Imaging Findings, and Prognosis for Muscle Strength Recovery in Surgical Infraclavicular Brachial...

Area of Science:

• Orthopedics
• Neurosurgery
• Medical Imaging

Background:

• Infraclavicular brachial plexus injuries (IBPIs) were historically managed non-surgically.
• Recent evidence suggests surgical intervention may be beneficial for traumatic IBPIs.

Purpose of the Study:

• To characterize injury patterns and associated injuries in traumatic IBPIs.
• To assess the accuracy of preoperative ultrasound and MRI neurography against surgical findings.
• To report outcomes following surgical treatment for IBPIs.

Main Methods:

• Retrospective review of 148 patients with traumatic IBPIs undergoing surgery (1995-2021).
• Exclusion of patients with supraclavicular injuries, stretch injuries, or non-traumatic brachial plexus dysfunction.
• Analysis of injury types, imaging concordance, surgical procedures, and functional recovery.

Main Results:

• Motor vehicle accidents were the primary cause (74%); scapular fractures occurred in 22%.
• Isolated nerve injuries were common (58.8%), particularly to the musculocutaneous nerve (40.6%).
• Ultrasound and MRI neurography showed high concordance with surgical findings; nerve transfers were frequent (46%), with significant muscle strength improvement observed post-surgery.

Conclusions:

• Traumatic IBPIs often result from high-energy trauma and may involve associated fractures.
• Preoperative imaging is largely reliable in predicting surgical findings for IBPIs.
• Surgical intervention, particularly nerve transfers, offers a good prognosis for muscle recovery in IBPI patients.