Factors Affecting Shoulder and Elbow Functions in Traumatic Brachial Plexus Surgery.

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Reconstructive Surgery

Background:

• Traumatic brachial plexus palsy (TBPP) significantly impairs upper extremity function, particularly in young adults.
• Surgical intervention is crucial for functional restoration, but outcomes vary based on clinical and technical factors.

Purpose of the Study:

• To assess the impact of injury etiology and surgical techniques on shoulder and elbow function in adult TBPP patients.
• To identify prognostic factors influencing functional recovery after surgical treatment for TBPP.

Main Methods:

• Retrospective cohort study of 57 adult TBPP patients (April 2015-January 2023).
• Injuries classified anatomically (C5-6, C5-6-7, pan-plexus) and by mechanism (accidents, falls, etc.).
• Surgical strategies included neurolysis, nerve repair, nerve grafting, and various nerve transfers; functional outcomes assessed using Gilbert-Raimondi scale and joint-specific measures at 24-month follow-up.

Main Results:

• Most patients were male (91.2%); motorcycle accidents were the leading cause (54.4%).
• Pan-plexus injuries (43.9%) and C5-6-7 injuries (42.1%) were most common.
• Functional recovery rates varied by lesion severity: C5-6 (87-100%), C5-6-7 (50-72%), pan-plexus (25-40%). Injury mechanism and adjunct procedures did not significantly impact outcomes.

Conclusions:

• Anatomical injury severity is a key prognostic factor in traumatic brachial plexus surgery.
• Various surgical techniques facilitate meaningful recovery, with selection based on lesion extent and patient factors.
• No single surgical technique proved universally superior; treatment is individualized.