Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents (original) (raw)
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An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre
Indian Journal of Plastic Surgery, 2012
Background: Epidemiological studies on traumatic brachial plexus injuries are few and these studies help us to improve the treatment, rehabilitation of these patients and to allocate the resources required in their management. Epidemiological factors can vary in different countries. We wanted to know the situation in an Indian centre. Materials and Methods: Data regarding age, sex, affected side, mode of injury, distribution of paralysis, associated injuries, pain at the time of presentation and the index procedure they underwent were collected from 304 patients. Additional data like the vehicle associated during the accident, speed of the vehicle during the accident, employment status and integration into the family were collected in 144 patients out of the 304 patients. Results: Road traffic accidents accounted for 94% of patients and of the road traffic accidents 90% involved two wheelers. Brachial plexus injury formed a part of multitrauma in 54% of this study group and 46% had ...
Injury, 2014
Brachial plexus injury (BPI) is a very mutilating lesion which typically affects young men of productive age. Therefore BPI has a serious socio-economic impact. 1,2 There are two major mechanisms and types of BPI. One is a traction injury, which results in the avulsion or rupture of one or more cervical roots and the other is direct injury to the trunks, cords and nerves of the brachial plexus. BPI occurs in approximately 5% of polytrauma patients involved in motorcycle crashes and in 3-4.8% of patients who experience a serious winter sports injury. While motorcycle collisions are the most common cause of BPI in adults, 1 car crashes and pedestrian accidents predominate in children. 3 BPI is typically a closed lesion and more than 50% of patients need operative reconstruction of affected brachial plexus elements. The rupture or avulsion of upper roots (C5-6 AE C7) is the most common type of BPI (upper brachial plexus palsy, weakness of the shoulder girdle and elbow flection). A complete lesion with avulsion of all roots is less common. The avulsion of lower roots only (C8-T1, lower BPI, weakness of the hand movements) is very rare since it is usually accompanied by a rupture of the upper roots as well. Upper roots are more fixated in intervertebral foramina which results in a greater tendency to rupture. 5 Better resuscitation techniques, which have led to increased survival of patients after polytrauma, has increased the total number of BPIs. 4,6 Patients with supraclavicular lesions usually have more coincident severe injuries than patients with infraclavicular lesions. A detailed examination is often not possible due to coma or multiple fractures. Moreover, many injuries initially appear as complete lesions because of neurapraxia (functional block). Neurological impairment is often detected after the patient comes out of a coma or after primary treatment (surgical treatment of Injury, Int. J. Care Injured 45 (2014) 223-226
Journal of Evidence Based Medicine and Healthcare, 2015
BACKGROUND: Epidemiological studies on traumatic brachial plexus injuries are few and these Studies help us to improve the treatment, rehabilitation of these patients and to allocate the resources required in their management. Epidemiological factors can vary in different countries. We wanted to know the situation in an eastern Indian Centre. MATERIALS AND METHODS: Data regarding age, sex, affected side, mode of injury, distribution of paralysis, associated injuries, and pain at the time of presentation and the index procedure they underwent were collected from 30 patients. RESULTS: Road traffic accidents accounted for 76.6% of patients and of the road traffic accidents 90% involved two wheelers. Brachial plexus injury formed a part of multitrauma in 54% of this study group and 46% had isolated brachial plexus injury. Associated injuries like fractures, vascular injuries and head injuries are much less probably due to the lower velocity of the vehicles compared to the western world. The average time interval from the date of injury to exploration of the brachial plexus was 3 to 6 month and 20 (66.7%) patients presented to us within this duration. Fifty-seven per cent had joined back to work by an average of12 month.
Brachial Plexus Injuries in Adults: Evaluation and Diagnostic Approach
ISRN Orthopedics, 2014
The increased incidence of motor vehicle accidents during the past century has been associated with a significant increase in brachial plexus injuries. New imaging studies are currently available for the evaluation of brachial plexus injuries. Myelography, CT myelography, and magnetic resonance imaging (MRI) are indicated in the evaluation of brachial plexus. Moreover, a series of specialized electrodiagnostic and nerve conduction studies in association with the clinical findings during the neurologic examination can provide information regarding the location of the lesion, the severity of trauma, and expected clinical outcome. Improvements in diagnostic approaches and microsurgical techniques have dramatically changed the prognosis and functional outcome of these types of injuries.
Traumatic upper plexus palsy: Is the exploration of brachial plexus necessary?
European Journal of Orthopaedic Surgery & Traumatology, 2018
Brachial plexus injuries are major injuries of the upper limb resulting in severe dysfunction usually in young patients. Upper trunk injuries of the brachial plexus account for approximately 45% of brachial plexus injuries. Treatment options for upper trunk brachial plexus injuries include exploration of the plexus and microsurgical repair using nerve grafts or nerve transfers. Several published studies presented the results of both techniques, but there are few studies which compared these two techniques. This article summarizes the treatment options for upper trunk brachial plexus injuries, discusses the merits and demerits of each technique, and presents authors' proposed treatment for these injuries.
Injury mechanisms in supraclavicular stretch injuries of the brachial plexus
Hand Surgery and Rehabilitation, 2016
The aim of this study was to describe the mechanisms involved in stretch injuries of the brachial plexus. One hundred and fifty consecutive patients with supraclavicular brachial plexus injuries (BPI) were asked about the mechanism of injury during the actual injury event, particularly about the type of trauma to their shoulder, shoulder girdle and head. Fifty-seven of the patients provided enough information about their accident to allow for analysis of the shoulder trauma. The injury mechanism for all patients having upper root or total palsy (n = 46) was described as a direct vertical impact to the shoulder. In 44 of these patients, the trauma followed a motorcycle accident and, in most of them, the patient hit a fixed vertical structure before falling to the ground. The injury mechanism for the lower root palsy cases (n = 11) was variable. The most frequent mechanism was forceful anterior shoulder compression by a car seat belt. We found that injury mechanisms differed significantly from the ones commonly discussed in published studies.
Traumatic brachial plexus palsy in children
Annales de chirurgie de la main et du membre supérieur : organe officiel des sociétés de chirurgie de la main = Annals of hand and upper limb surgery, 1990
We have reviewed 25 children with traumatic brachial plexus palsy during the last fifteen years. Motor vehicle injury was responsible for 17 of these cases. Associated lesions were noted in 68%. All lesions were supraclavicular, including C5-C6 in 5 cases, C5-C7 in 5 cases and C5-T1 in 13 cases. Precise data was not available for two patients. Root avulsion was noted in 63% of our patients. Neurotization was performed in eight of the sixteen patients who had surgical repair. Tendon transfers were performed in 9 patients, 5 of which have had a previous surgical plexus repair. Elbow flexion was restored in all but one, and protective sensation of the hand in 40% of the patients undergoing plexus surgery. We conclude that surgery should be performed on children who have no evidence of nerve regeneration three months following traumatic brachial plexus palsy.
Indian Journal of Plastic Surgery
Background The majority of brachial plexus injuries (BPIs) are caused by trauma; most commonly due to two-wheeler road accidents. It is important to determine whether the lesion in question is pre-ganglionic or post-ganglionic for purposes of surgical planning and prognosis. Diagnostic testing helps the surgeon to not only decide whether surgical intervention is required, but also in planning the procedure, thereby maximizing the patient's chances of early return to function. The aim of the study was to determine the diagnostic efficacy of electrodiagnostic studies (Edx) and magnetic resonance imaging (MRI) individually, and in unison, in detecting the type and site of BPI by comparison with intraoperative findings (which were used as the reference standard) in patients with posttraumatic BPI. Methods It is an observational cross-sectional prospective randomized study, wherein 48 patients with BPI underwent a detailed clinical and neurological examination of the upper limb, Edx,...