Prevention of Brachial Plexus Injuries: A Comprehensive Review of Causes, Challenges and Protective Strategies

Brachial plexus injuries (BPIs) are present in 1.2% of polytrauma and result in significant morbidity and functional impairment. Despite advancements in surgical repair, recovery outcomes remain suboptimal, emphasizing the need for preventive strategies. This narrative review explores risk factors, clinical settings, and evidence-based preventive measures for brachial plexus injury(BPI).

A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar databases, covering articles published in English between 2000 and 2024. Search terms included combinations of 'brachial plexus injury,' 'risk factors,' 'prevention,' 'perinatal brachial plexus palsy,' 'iatrogenic nerve injuries,' and 'trauma-related nerve injuries.' Studies were screened by two independent reviewers, and only original articles focusing on BPIs were included. Duplicates and unrelated articles were excluded.

A total of 42 studies were included after screening 3614 records. These comprised systematic reviews, cohort studies, case series, and case reports, covering obstetric, traumatic, iatrogenic, and radiation-induced BPIs. Key preventive strategies identified include optimized delivery practices, road safety measures, careful intraoperative positioning, and precise radiation planning. Obstetric BPI: Optimal delivery techniques, avoidance of excessive traction, and early caesarean section in high-risk cases significantly reduce the incidence of birth brachial plexus palsy (BBPP). Traumatic BPI: Road safety measures, helmet use, and implementation of exclusive motorcycle lanes (EMCLs) reduce the risk of traumatic BPI in high-incidence regions. Iatrogenic BPI: Intraoperative nerve monitoring, optimal patient positioning, and regular assessment during prolonged surgeries minimize the risk of iatrogenic nerve injury. Radiation-induced BPI: Precise radiation planning, shielding of neural structures, and regular monitoring reduce the risk of radiation-induced neuropathy.

Prevention of BPI requires a multidisciplinary approach, integrating optimized surgical techniques, patient safety protocols, and public health initiatives. While existing strategies demonstrate effectiveness, further clinical studies are warranted to establish standardized guidelines for BPI prevention across various clinical settings.

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