Treatment and Outcomes of Pediatric Traumatic Brachial Plexus Injuries

Traumatic brachial plexus injuries (TBPIs) in children are rare, and clinical characteristics and outcomes are poorly understood. This study provides a large descriptive cohort of pediatric TBPIs, including presentation, treatment, and outcomes, along with comparison analysis to brachial plexus birth injuries (BPBI).

A retrospective cohort was created of patients aged ≤18 years with TBPI from a single institution between 2001 and 2021. Demographics, injury characteristics, and treatment details were collected. Outcome measures were summarized at presentation and latest follow-up, including Active Movement Scale (AMS), Toronto Test score, and Mallet classification. One hundred eighty-nine cases of BPBI from our institutional BPBI registry were used as a comparison.

Fifty-one patients with TBPI were identified. Mean age at presentation was 14.1 years (IQR, 12.6-17.2) and sex was majority male (67%). Common mechanisms include motor vehicle accidents (35%) and sports (28%), and 27.5% had associated fractures. Fifty-seven percent of TBPI were isolated to the extended upper trunk, compared to 75% of BPBI. Pre-ganglionic injury was identified in 31% of patients, post-ganglionic injury in 3%, and no MRI-detectable injury in 66%. Forty-one percent (21/51) of TBPI patients underwent microsurgery compared to 13% (24/189) of the BPBI cohort (P < .001). At presentation, TBPI patients had lower Mallet scores (11 vs 19; P < .001) and similar AMS (65 vs 83; P = .07) and Toronto (7.1 vs 8.8, P = .09) scores compared to the BPBI cohort. However, at follow-up TBPI patients had higher AMS scores (103 vs 93, P = .03) and similar Toronto (10 vs 9.3, P = .08) and Mallet (17 vs 21; P = .30) scores.

While TBPIs are rare in children, data from BPBI studies may help guide understanding of patterns and outcomes. Pediatric TBPIs have higher rates of global plexus injuries and primary nerve surgery. Functional scores for TBPI are worse at presentation but improve to levels comparable to BPBI after surgery, suggesting a ceiling effect after brachial plexus injuries, whether traumatic or birth-related.

(1)Traumatic brachial plexus injuries (TBPI) are rare in children, so an understanding of evaluation and treatment of the more common brachial plexus birth injuries (BPBI) can be helpful.(2)Pediatric TBPI patients have a higher rate of global injuries and need for primary nerve surgery than BPBI patients.(3)While functional scores for TBPI patients are worse at presentation than BPBI patients, they improve to similar levels with treatment.

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