Brachial Plexus Injury Surgical Service in Time of Coronavirus Disease 2019 Pandemic Experience from a Single Tertiary Orthopaedic Hospital in Indonesia (original) (raw)
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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.
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 ...
Epidemiological Study of Traumatic Brachial Plexus Injuries
Acta Ortopédica Brasileira
Objective: To conduct an epidemiological study on brachial plexus injuries, through data collection of patients treated in the Hospital São Paulo, which is the referral center for high complexity in this region. Methods: We conducted a retrospective study with a review of the electronic medical records of the Hospital, from August 2008 to June 2013. Results: We estimated an 1.88/100,000 annual incidence, considering that the Hospital is the only referral center for brachial plexus injuries. The mean time between injury and the first visit to the reference hospital was 8.25 months. The mean time interval between injury and surgery was 11.25 months. The percentage of total injuries was 33%, while the upper and middle trunk injuries were 33% and 28%, respectively. Conclusion: We observed many aspects in common with those reported by other centers of excellence in Brazil such as: sex, age and mechanism of injury. However, some findings were different from most other epidemiological stud...
Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country
Journal of Reconstructive Microsurgery
Background Brachial plexus injuries (BPI) cause severe physical disability and major psycho-socioeconomic burden. Although various countries have reported BPI incidence, the data from Indonesia as the fourth most populated country in the world remains unknown. We aim to assess the distribution of traumatic BPI, patients' characteristics, and treatment modalities in Indonesia. Methods A retrospective investigation was performed comprising 491 BPI patients at a tertiary referral hospital in Indonesia from January 2003 to October 2019. Demographic and outcomes data were retrieved from medical records. Results The average BPI patients' age was 27.3 ± 11.6 years old, with a male/female ratio of 4.6:1. Motorcycle accidents caused the majority (76.1%) of all BPI cases. Concomitant injuries were present in 62.3% of patients, dominated by fractures (57.1%) and brain injuries (25.4%). BPI lesion type was classified into complete (C5-T1, observed in 70% patients), upper (C5-C6, in 15% ...
Impact of the COVID-19 Pandemic on the Practice of Hand and Upper Extremity Surgeons
Cureus
The purpose of this study was to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the practice of hand and upper extremity surgeons. Methods We assessed how the pandemic affected the practice on multiple fronts including professional, personal, and practice aspects. The survey was conducted through an online questionnaire that had six sections: demographics, clinic, elective surgery, emergency surgery, urgent surgery, and human resources. The survey was sent to 586 Kleinert Society members who are all practicing hand and upper extremity surgeons. Results We received 35 responses from the United States and 53 from the rest of the world. Based on our findings, the clinic volume was reduced by >50% in the early stages, subsequently returning to a level that was 25-50% lower than pre-COVID-19 times in later stages. A corresponding decrease in elective surgeries was also noted. The need for preoperative COVID-19 tests added to the logistics of surgery, causing delays of three to six hours for emergency cases and >24 hours for urgent cases. The hand surgeons witnessed multiple furloughs, layoffs, and even COVID-19 infections among nursing and support staff. Most hand surgeons continued to perform urgent and emergency surgeries during the pandemic. The application of telemedicine was not popular and had multiple drawbacks. Hand surgeons are modifying their practice by adopting measures such as social distancing, reducing the clinic volume, and using personal protective equipment (PPE). Conclusions As COVID-19 is likely to prevail for the foreseeable future, these measures are here to stay. The initial reduction in the clinic and elective volume has improved but has not reached pre-COVID-19 levels, suggesting a slow recovery. As reopening measures will lead to more people rejoining employment, subsequently, more patients with hand-related conditions are likely to present to the clinics. Rapid COVID-19 testing and supply of PPEs will play a crucial role in the near future to enable hand surgeons to continue their service while taking care of their personal health.
Impact of the First Six Months of the Covid-19 Pandemic on Orthopedic and Hand Trauma Surgery
Eastern Journal of Medicine, 2021
Reduced mobility due to COVID-19 prevention measures caused major changes in the number and types of orthopedic trauma cases. This study aimed to compare the profile of trauma-related general orthopedic surgery and hand surgery cases between the first six months of the COVID-19 pandemic and the corresponding periods of previous years in order to determine strategies for managing orthopedic traumas in unusual circumstances such as pandemics. Patients over 18 years old who underwent orthopedic surgery due to trauma were grouped according to sur gery date as pre-pandemic group 1 (G1, March 16-September 18, 2018), pre-pandemic group 2 (G2, March 18-September 20, 2019), and the pandemic group (G3, March 19-September 21, 2020). Between-group differences with p<0.05 were considered significant. The study included a total of 3522 patients: 1351 in G1, 1427 in G2, and 744 in G3. There was a significant decrease in the number of patients in G3 compared to the other groups (p =0.001), while the number of hand surgeries did not differ significantly between the groups. As a result, the ratio of hand trauma surgeries to general orthopedic traumas was significantly higher in G3 (p <0.05). During the COVID-19 pandemic, there was a decrease in orthopedic trauma surgeries and an increase in hand trauma surgeries. In this period of increased hand traumas, hand surgeons should be encouraged to intervene remotely using technology (telemedicine).
Functional Outcomes after Treatment of Traumatic Brachial Plexus Injuries: Clinical Study
Turkish journal of trauma & emergency surgery, 2013
BACKGROUND: The aim of this study is to evaluate functional outcome and quality of life using statistically validated tools. METHODS: Participating patients were called and asked questions from the Short Form 36 (SF-36), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, a pain scale and an additional question on their satisfaction with surgery. RESULTS: A total of 33 patients were operated by a single surgeon (MI) between 1997 and 2010 at the Neurosurgery Department of Istanbul School of Medicine. Three of these patients refused to participate and three other patients were excluded, leaving 27 patients, with an average follow-up of 79,6 months, for review. The most common cause of traumatic brachial plexus injuries (TBPI) was motor vehicle accidents. Fourteen patients had isolated supraclavicular injuries and three patients had infraclavicular injuries. The remaining 10 patients' injuries were both supra-and infraclavicular. Avulsion was encountered in three patients. The patients who were operated within the first six months after trauma represented significantly better scores in DASH, SF-36 and pain scale. CONCLUSION: Statistically validated tests like DASH and SF-36 questionnaires are valuable tools for evaluating TBPI patients. Centers specialized in treating TBPI with surgery may use these tests pre-and postoperatively which lead to objective personalized evaluation of patients' subjective symptoms.
Clinics in Orthopedic Surgery
Brachial plexus injury (BPI) is one of the most disabling peripheral nerve diseases. If left untreated, it will cause impairment on the upper extremity. 1) Moreover, BPI commonly occurs in productive ages, which may lead to a colossal socioeconomic burden on the patient. 2,3) In the United States, it is estimated that 0.6-3.9 per 100,000 person-years is affected by BPI. In our center, there are approximately 35 cases of BPI per year, which is commonly caused by motor vehicle accidents in patients aged 21-30 years. 2) Treatment for BPI keeps evolving alongside peripheral nerve reconstruction techniques. Some of the established modalities for surgeons are neurolysis, nerve repair, nerve grafting, and nerve transfer. The goal of the therapy is to regain clinical function and improve the quality of life. Despite advancements in the treatment of
European Journal of Plastic Surgery
Background Nerve injuries are a common occurrence among hand injuries, which at the time of the COVID-19 emergency, did not appear to have reduced their incidence. The treatment of these injuries is urgent, but the pandemic has led to a reduction in the availability of resources and a consequent reorganization of activities. Principles about Wide-Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery expressed by LaLonde helped hand surgeons to adapt to this new condition by demonstrating a possible outpatient pathway for the treatment of hand traumatic conditions. In the present study, we bring our experience in nerve repair at time of COVID-19 emergency. Methods We retrospectively enrolled in this study all patients surgically treated for a peripheral nerve injury (PNI) during the COVID-19 emergency period from March 2020 to March 2022. Demographical, anamnestic, surgical, and postoperative data were recorded and analyzed. Persisting Tinel was set as the primary outcome, wh...
Bali Medical Journal, 2022
Introduction: Traumatic brachial plexus injury (TBPI) is a debilitating and devastating injury that significantly impacts individuals' quality of life. This study aimed to evaluate the functional outcomes, pain improvement and quality of life after external neurolysis surgery in TBPI patients. Methods: A retrospective study was conducted at Dr Soetomo Hospital in Surabaya, Indonesia. Data of TBPI patients who were operated with external neurolysis surgery from 2003 to 2020 were collected. The functional outcome was measured using disabilities of the arm, shoulder, and hand (DASH) score, the pain assessment with pain visual analog score (VAS) and the quality of life with 36-item short-form (SF-36). The outcomes were also compared between those who had the surgery less or more than 6 months after the injury. Results: A total of 493 TBPI patients were diagnosed between 2003 to 2020. Out of total, 37 patients had external neurolysis surgery, mean age of 31±12.5 years, were included in the analysis. External neurolysis surgery in TBPI patients improved all DASH, VAS and SF-36 scores and these improvements were likely influenced by sex, age, occupation, affected side and the level of the injury. In addition, our data also suggested that the patients who had external neurolysis surgery before 6 months had better outcomes than those after 6 months after the injury in term of DASH, VAS and SF-36 scores. Conclusion: In TBPI cases, earlier external neurolysis surgery could result in better pain reduction, functional outcome and quality of life outcomes.