EPIDEMIOLOGY OF BRACHIAL-PLEXUS INJURIES IN A MULTITRAUMA POPULATION

OBJECTIVE: The purpose was to identify the prevalence, causative facto rs, injury types, and associated injury patterns in multitrauma patien ts who sustained brachial plexus injuries. METHODS: A retrospective re view of a prospectively collected and computerized database and a char t review were performed. RESULTS: Brachial plexus injuries were identi fied in 54 of 4538 (1.2%) patients presenting to a regional trauma fac ility. Young male patients predominated. Motor vehicle accidents were the most frequent cause overall, but only 0.67% of such accidents resu lted in plexus injuries. Conversely, 4.2% of motorcycle accident victi ms and 4.8% of snowmobile accident victims suffered brachial plexus in juries. Injuries were supraclavicular for 62% of patients and infracla vicular for 38%. Supraclavicular injuries were more likely to be sever e (Sunderland Grade 3 or 4), compared with infraclavicular injuries, w hich were neurapraxic in 50% of cases (P < 0.01). The former therefore required surgical exploration and reconstruction more often (52 versu s 17%; P < 0.05). Associated injuries included closed head injuries wi th loss of consciousness in 72% of patients (coma in 19%), cervical sp ine fractures in 13%, and clavicle, scapular, or humeral fractures and shoulder dislocations or sprains in 15 to 22%. Rib fractures were obs erved in 41% and were complicated by internal thoracic injuries in a s imilar percentage of cases. The injury severity score ranged from 5 to 59, with a mean of 24, and two patients died. CONCLUSION: Brachial pl exus injuries afflict slightly more than 1% of multitrauma victims. Mo torcycle and snowmobile accidents carry especially high risks, with th e incidence of injury approaching 5%. Head injuries, thoracic injuries , and fractures and dislocations affecting the shoulder girdle and cer vical spine are particularly common associated injuries. Supraclavicul ar injuries are more common, are of more severe grade, more often requ ire surgery, and are associated with worse prognosis, compared with in fraclavicular injuries.