Traumatic Brachial Plexus Injury

Hahn, Soo Bong; Min, Byoung Hyoun

Abstract

Even though the brachial plexus injury causes catastrophic loss of function of the corresponding upper extremity, it must be treated by conservative method for a long duration of time. But recently more challengeable surgical approaches such as neurorrhapy, nerve grafting, neurotization, muscle transfer and myocutaneous flap are being attempted. We have managed 26 cases of brachial plexus injury since 1979, and have obtained results as follows: 1. The most common cause was traffic accident(10 cases) including motor cycle accident. 2. The most frequent injury was due to traction mechanism(9 cases). 3. It required an average of 7.2 weeks for the diagnosis and therapeutic evaluation of brachial plexus injury. 4. Humerus fractures were the most common associated injury(7 cases). 5. Electromyography was conducted in most cases(20 cases), and cervical myelography was done in 5 cases. 6. The most common single injuries occured at the root level(7 cases) and next common site was trunk level(5 cases). But it happened most often in mixed type injury(12 cases). 7. Loss of motor power was most severe in finger flexors, and wrist flexors and extensors after brachial plexus injuries. But recovery was more rapid and complete in elbow flexors and deltoid. 8. If pain persisted for more than 6 months, the prognosis was relatively poor. 9. Surgical procedures were performed in 6 cases, one case of neurorrhapy, 2 cases of neurolysis, 2 cases of myocutaneous flap and one case of muscle transfer. 10. For the cases which did not improve with conservative mangement, operative procedures led to better results after determining appropriate indication.