Surgical outcome of brachial plexus surgery: our experience
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253407Keywords:
Brachial plexus injury, Global brachial plexus injury, Microsurgical management, Nerve transfer, Nerve grafting, Upper limb recoveryAbstract
Background: Brachial plexus injuries (BPIs) result in significant functional impairments, especially in developing countries like Bangladesh, where road traffic accidents are common. Advances in microsurgical techniques, such as nerve transfers and grafting, have improved outcomes. This study aims to evaluate the surgical outcomes of BPIs and contribute to optimizing treatment strategies for better recovery and functional restoration in patients with these complex injuries. To evaluate surgical outcomes, assess functional recovery and compare various surgical techniques for BPI management.
Methods: This prospective observational study, conducted from May 2013 to March 2025, included 95 patients with post-traumatic BPIs from four major hospitals. Surgical interventions, including nerve transfers and grafting, were performed based on injury type. Preoperative and postoperative data were collected, including motor function assessment and patient rehabilitation outcomes, with follow-up at regular intervals for recovery monitoring.
Results: The study included 95 patients with brachial plexus injuries, predominantly in the 18–30 age group (63.16%) and male (63.16%). The most common injury type was upper brachial plexus (42.1%), followed by global injuries (21.1%). Nerve transfers, especially Oberlin II, were the most performed surgery (31.6%). Postoperatively, 42.1% achieved good motor recovery (Grade 4), while 26.3% had excellent recovery (Grade 5). The follow-up ranged from 0–25+ months.
Conclusions: Microsurgical techniques have improved brachial plexus injury management, but full upper limb function recovery remains suboptimal, especially in global injuries.
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References
Lee SK, Wolfe SW. Nerve transfers for the upper extremity: new horizons in nerve reconstruction. J Am Acad Orthop Surg. 2012;20(9):506-17. DOI: https://doi.org/10.5435/JAAOS-20-08-506
Bertelli JA, Ghizoni MF. Results of nerve transfers for the restoration of elbow flexion in upper brachial plexus injuries. J Neurosurg. 2004;101(3):365-70. DOI: https://doi.org/10.3171/jns.2004.101.5.0770
Socolovsky M, Paez M, Bonilla G. Nerve transfers in brachial plexus injuries: a series of 100 cases. J Neurosurg. 2016;125(2):350-61.
Lee SH, Abdullah S, Soh EZF. The outcome of neurotization of brachial plexus injury in a tertiary centre: a nine-year review. Cureus. 2022;14(3):23394.
Bhandari PS, Deb P, Bhargava P. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury. Indian J Plast Surg. 2009;42(2):150-60. DOI: https://doi.org/10.4103/0970-0358.59272
Bertelli JA, Ghizoni MF. Transfer of the radial nerve branch to the long head of the triceps to the axillary nerve for shoulder function restoration in C5-C6 brachial plexus injuries. J Neurosurg. 2015;122(1):121-6.
Ray WZ, Mackinnon SE. Clinical outcomes following median to radial nerve transfers. J Neurosurg. 2011;114(6):1521-7.
Malessy MJ, Pondaag W. Nerve transfers in brachial plexus injuries. Neurosurg Clin N Am. 2009;20(1):15-23. DOI: https://doi.org/10.1016/j.nec.2008.07.024
Chuang DC. Nerve transfers in adult brachial plexus injuries: indications, techniques and outcomes. J Hand Surg Am. 2008;33(4):549-57.
Midha R. Nerve transfers for severe brachial plexus injuries: a review. Neurosurg Focus. 2004;16(5):5. DOI: https://doi.org/10.3171/foc.2004.16.5.6
Kim DH, Murovic JA, Tiel RL, Kline DG. Surgical management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. J Orthop Sci. 2013;18(3):409–17.
Flores LP. Acute brachial plexus lesions: diagnostic and prognostic factors. Microsurgery. 2013;33(4):281–8.
Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurg Focus. 2013;33(1):2.
Bertelli JA, Ghizoni MF. Results of nerve grafting and nerve transfers in brachial plexus injuries. Hand Clin. 2013;29(2):123–36.
Malessy MJA, Thomeer RTWM. Improving selectivity in nerve transfers for functional restoration. J Neurosurg. 2013;118(5):1137–1145.
Bhandari PS, Jain RK. Primary management of brachial plexus injuries. Hand Microsurg. 2013;2(1):7–16.
Terzis JK, Kostopoulos VK. Outcomes of brachial plexus reconstruction in adults. Neurosurg Focus. 2013;33(1):5.
Siqueira MG, Martins RS. Surgical treatment of adult traumatic brachial plexus injuries: an overview. J Clin Neurosci. 2013;20(7):941–50.
Narakas AO. The restoration of elbow flexion in brachial plexus injuries. J Hand Surg Eur. 2013;38(3):294–303.
Moore AM, Kasukurthi R, Magill CK, Farhadi HF, Borschel GH, Mackinnon SE. Limitations of nerve repair techniques in the upper extremity. Microsurgery. 2013;33(4):271–81.
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