THE SURGICAL-TREATMENT OF BRACHIAL-PLEXUS INJURIES

Background: Brachial plexus injuries cause a devastating loss of funct ion in the arm. The aim of this study was to review the results of sur gical treatment of patients with brachial plexus injuries. Methods: Fo rty-seven patients were reviewed. Five patients did not undergo surger y. Forty-two patients had exploration and 38 had primary surgery with neurolysis, nerve graft or neurotization or a combination. Four patien ts had other reconstructive surgery primarily. Secondary reconstructiv e surgery consisted of joint fusions and tendon transfers to enhance o r replace the primary surgery. Results: Nerve grafting achieved 62% Me dical Research Council (MRC) grade M3 or better. Intercostal neurotiza tion (ICN) of the musculocutaneous nerve (MCN) for elbow flexion achie ved M3 or better in 69% of patients. Conclusions: Primary nerve recons truction, combined with joint fusions and tendon transfers, provides a worthwhile return of function to many patients;We advise early explor ation (i.e. within 2 weeks when possible) for patients with complete C 5-T1 lesions or C5, 6,7 lesions in conjunction with high energy injuri es. In order to obtain optimal results patients with brachial plexus i njuries Should be referred to appropriate units as early as possible.