Operative treatment with nerve repair can restore function in patients with traction injuries in the brachial plexus

Abstract

Introduction: Brachial plexus injuries are usually a result of road traffic accidents and a cause of severe disability that typically affects young adult males. In 2010, a national centre was established for referral of these cases from Danish trauma centres. In this paper, we report on our surgical activity and reflect on the role for this new national centre. Methods: Records from all our operated patients were reviewed retrospectively. For outcome analysis, we focused on patients who had sustained traction injuries with a surgical follow-up exceeding one year. We used either nerve grafting or transfers for nerve repairs based on the pattern of nerve injury seen intraoperatively. Results: Overall, 24 patients were operated, and 12 patients were included in the outcome analysis. The six patients with upper brachial plexus palsies all regained shoulder function and useful elbow flexion. Of the six patients with complete brachial plexus palsies, four regained shoulder function, while only one regained useful elbow function, and this was after nerve transfers. Conclusion: Operative treatment provides satisfactory results in patients with upper brachial plexus palsies, while improvement is warranted in patients with complete brachial plexus palsies. Our data suggest that nerve transfers may result in a better functional outcome than nerve grafting. We believe that there is a role for a Danish centre for the treatment of these injuries.