gms | German Medical Science

Objective: Traumatic brachial plexus lesions (TBPL) in adults are usually secondary to traffic accidents and gunshot wounds. Surgical treatment is indicated when the patients did not improve after conservative treatment. Outcome of surgery is determined by the clinical examination of the patient and electrophysiological assessment. The aim of this study is to present long-term clinical outcomes of patients who underwent surgical treatment for TBPL.

Method: The data of 126 patients who underwent surgical treatment for TBPL secondary to gunshot wounds and traffic accidents were reviewed retrospectively. All of them were male with a mean age of 21.2 years. All of the patients did not improve despite conservative treatment and underwent surgery at least 3 months after the injury. Supraclavicular approach was used in 98 patients while infraclavicular approach in 24 and combined approach in 4 patients. Patients were followed-up by periodical clinical examination and electromyographies. The outcome of surgery was classified as excellent, good, moderate and poor based on clinical examination.

Results: Gunshot wounds were the causes of TBPL in 112 patients while motor vehicle accidents were in 14 patients. Bullets were the most wounding agent in gunshot wounds. Surgical treatment was performed between 3 and 10 months after injury. Excellent clinical outcome was observed in 12, good outcome in 75, moderate in 4, poor in 7 patients who underwent surgery between 3 and 6 months and moderate outcome in 16, poor outcome in 12 patients who underwent surgery between 6 and 10 months. Excellent and good outcomes were mostly observed in supraclavicular approach while moderate and poor outcomes in infraclavicular approach. Mean follow-up period was 48 months, ranged between 24 and 86 months.

Conclusions: Better long-term surgical outcome in TBPL is associated with the time and technique of surgery. The cause of injury is not a prognostic factor in TBPL. Preoperative neurological condition of the patient is important but not significantly affecting the clinical long-term outcome.