Evaluation of Triple Neurotization Technique as a Single Procedure in Adult Traumatic Brachial Plexus Injury

Abstract

Introduction: Brachial plexus injuries are common and result in significant disabilities. This study evaluated the outcome of triple neurotization as a single procedure for upper trunk brachial plexus injury. Patients and Methods: Some 25 adult consecutive patients with injured upper trunk brachial plexus who underwent microscopic reconstructive surgery using triple neurotization technique in the authors' institute were recruited in this study. Data on operative and functional outcomes were captured. Modified Narkas scale was used to evaluate the shoulder function in addition to Waikakul scale which was used to evaluate the elbow function. Data were analyzed with respect to short and long term with a median follow-up duration of two years. Results: Assessment of the recovered shoulder abduction was excellent in 48\% (n=12), good in 24\% (n=6), fair in 16\% (n=4), and poor in 12\% of cases (n=3). Shoulder external rotation recovery was excellent in 48\% (n=12), good in 12\% (n=3), fair in 12\% (n=3), and poor in 28\% of cases (n=7). Recovery of elbow flexion was excellent in 60\% (n=15), good in 12\% (n=3), fair in 12\% (n=3), and poor in 16\% of cases (n=4). The mean value of recovered shoulder abduction was 111.26 degrees (range: 70-150). The mean value of restored shoulder external rotation was 57.5 degrees (range: 45-70). The mean value of restored elbow flexion was 75 degrees (range: 55-120). Conclusion: Triple neurotization technique can be effective to restore elbow flexion, shoulder abduction, and external rotation in adult patients with upper trunk brachial plexus injury.