Al-Thani H, El-Menyar A, Asim M, Syed Y, Ghouri SI, Muneer M, Al-Hassani A, Al-Sulaiti M, Tabeb A. Management and outcome of blunt traumatic brachial plexus injuries in adult trauma patients: A retrospective study. World J Orthop 2026; 17(6): 121411 [DOI: 10.5312/wjo.v17.i6.121411]
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Ayman El-Menyar, MD, Department of Surgery, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
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Orthopedics
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Al-Thani H, El-Menyar A, Asim M, Syed Y, Ghouri SI, Muneer M, Al-Hassani A, Al-Sulaiti M, Tabeb A. Management and outcome of blunt traumatic brachial plexus injuries in adult trauma patients: A retrospective study. World J Orthop 2026; 17(6): 121411 [DOI: 10.5312/wjo.v17.i6.121411]
Author contributions: Al-Thani H contributed to conceptualization, methodology, writing, Al-Thani H and El-Menyar A contributed to formal analysis; Asim M and El-Menyar A contributed to data curation; El-Menyar A, Asim M, Al-Hassani A, Syed Y, Ghouri SI, Muneer M, Al-Sulaiti M, Tabeb A contributed to writing; all authors have read and agreed to the published version of the manuscript.
AI contribution statement: The language has been polished using Grammarly. The entire content of the main text (abstract, introduction, materials and methods, results, discussion and conclusion) of the article was not generated by artificial intelligence.
Institutional review board statement: This study was approved by the Research Ethics Committee at Medical Research Center, Hamad Medical Corporation. No direct contact with participants, and data were collected anonymously and retrospectively.
Informed consent statement: Not applicable for this retrospective analysis, and it has been waived by the institutional board review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement:sharing statement: Summarized data are given in the manuscript and tables, while de-identified raw data may be available upon reasonable request and subject to the required institutional approvals.
Corresponding author: Ayman El-Menyar, MD, Department of Surgery, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
Received: March 24, 2026 Revised: April 14, 2026 Accepted: May 13, 2026 Published online: June 18, 2026 Processing time: 85 Days and 16.3 Hours
Abstract
BACKGROUND
Traumatic brachial plexus injury (TBPI) is a debilitating condition characterized by nerve damage that impairs sensation and movement in the upper extremities.
AIM
To study the clinical presentation, management, and outcomes of TBPI.
METHODS
This retrospective observational study analyzed adults with TBPI between 2010 and 2024. Collected data encompassed demographics, injury severity and characteristics, management, and functional status.
RESULTS
Thirty-six TBPI patients were analyzed (94.4% male, mean age 28.6 years). Crashes involving motor vehicles (41.7%) and motorcycles (13.9%) were the primary causes. Pan-plexus injuries predominated (52.8%), followed by upper (30.6%) and lower (16.7%) TBPI, predominantly affecting nerve roots (55.6%). Associated injuries included humerus (16.7%), clavicle (16.7%), rib (13.9%), and spinal fractures (13.9%). Long-term outcomes were generally poor: 66.7% showed no recovery, 16.7% partial improvement, and only 16.7% full recovery.
CONCLUSION
This study highlights the significant functional deficits associated with TBPI. Conservative management constituted the primary treatment strategy; however, most patients exhibited persistent deficits. Motor recovery outcomes were notably limited, whereas sensory recovery showed comparatively more improvement. Surgical intervention was infrequent, reflecting the complexity of management. Overall, TBPI is severely debilitating with a low probability of complete functional restoration, emphasizing the critical need for early diagnosis, a multidisciplinary team, intervention, and sustained rehabilitation. Future multicenter studies should identify predictors to optimize surgical timing relative to conservative care.
Core Tip: Traumatic brachial plexus injury (TBPI) is a debilitating condition characterized by nerve damage that impairs sensation and movement in the upper extremities. TBPI are uncommon in polytrauma. Those patients not only experience physical impairments, such as loss of movement and sensation, but also significant psychological and financial challenges that impact their overall quality of life. Conservative management constituted the primary treatment strategy; however, most patients exhibited persistent deficits. Motor recovery outcomes were particularly poor in 25% of patients with no muscle contraction. In contrast, sensory recovery demonstrated comparatively better results. Surgical intervention was pursued in a minority of cases, using techniques such as nerve and tendon transfers, indicating the inherent complexity of managing TBPI. This highlights the crucial importance of early diagnosis, prompt intervention, a multidisciplinary team, and rehabilitation.
Citation: Al-Thani H, El-Menyar A, Asim M, Syed Y, Ghouri SI, Muneer M, Al-Hassani A, Al-Sulaiti M, Tabeb A. Management and outcome of blunt traumatic brachial plexus injuries in adult trauma patients: A retrospective study. World J Orthop 2026; 17(6): 121411
Traumatic brachial plexus injury (TBPI) is a debilitating condition characterized by nerve damage that impairs sensation and movement in the upper extremities[1]. TBPIs are uncommon, with a reported prevalence of 1.2% in polytrauma patients[2]. Notably, patients with TBPI not only experience physical impairments, such as loss of movement and sensation, but also significant psychological and financial challenges that impact their overall quality of life[1,2].
The primary mechanism of TBPI involves traction or compression of the brachial plexus nerves[3,4]. Furthermore, the etiology of TBPI differs by age group. In older patients, TBPI typically results from falls, with spontaneous recovery occurring in nearly 90% of cases[4]. In contrast, younger patients often develop TBPI following high-impact trauma, such as motor vehicle accidents, or minor shoulder injuries, including dislocations[5]. Motorcycle accidents represent the most reported mechanism of TBPI, accounting for 67% of cases, followed by car accidents at 14%[6]. Additionally, blunt blows with high-energy impact to the shoulder can cause TBPI[7]. Interestingly, an earlier study on surgically treated TBPI cases reported a predilection for right-sided involvement over left-sided limb[8].
Various associated injuries, including shoulder trauma, axillary artery rupture, or first rib fractures, should necessitate high suspicion for a TBPI[9]. Additionally, a quarter of TBPI cases present with concomitant severe head trauma, clavicle fractures, or scapular fractures[9]. The clinical presentation of TBPI varies by injury location: Supraclavicular injuries typically involve an internally rotated and adducted shoulder with a pronated elbow[2,9]. While infraclavicular injuries are uncommon, they may include axillary artery rupture and musculocutaneous, suprascapular, and axillary nerve injuries[10]. For diagnosis, radiographic imaging, such as computed tomography (CT), helps evaluate the level of nerve injury[9]; however, magnetic resonance imaging (MRI) is the gold standard due to its superior visualization of the entire brachial plexus and enhanced soft-tissue characterization[11,12]. Electrodiagnostic tests, including electromyography and nerve conduction velocity studies, may also be utilized[13]. We aim to analyze the epidemiological pattern, clinical presentation, management strategies, and long-term functional outcomes of blunt TBPI.
MATERIALS AND METHODS
This retrospective observational study analyzed data for all adult blunt TBPI patients who were admitted and treated at the level I trauma center over 15 years, from 2010 to 2024. Data were retrieved from the Qatar National Trauma Registry database and electronic medical records (CERNER). The TBPI diagnosis was confirmed through physical examination, radiological imaging (such as a CT scan and/or MRI), and electrodiagnostic tests. Patients with incomplete data, pediatric trauma patients, those who were dead on arrival, and those with non-traumatic brachial plexopathy were excluded.
The study collected a comprehensive set of parameters, including patient demographics and the mechanism of injury. Clinical assessments included Glasgow Coma Scale, Injury Severity Score, and Abbreviated Injury Scale scores for various body regions. Documented associated injuries included trauma to the head/neck, chest, and abdomen, as well as musculoskeletal injuries (dislocations of the shoulder/elbow; fractures of the scapula, humerus, ulna, ribs, clavicle, radius, and spine). For TBPI, data on injury type/Location, Sunderland Classification, and British Medical Research Council (BMRC) scale assessments (post-injury and long-term) were recorded. Management approaches (surgical vs conservative) and critical care interventions were analyzed, along with outcomes such as ventilator days, intensive care unit (ICU) and hospital length of stay, long-term functional recovery, and follow-up duration. The conservative treatment primarily included individualized rehabilitation measures such as physiotherapy, occupational therapy, splinting, pain management, and regular follow-up according to institutional practice.
Ethical approval was obtained from the Medical Research Centre. A waiver of informed consent was approved for this retrospective study because there was no direct patient contact and data were collected anonymously.
The data were expressed as n (%), means ± SD, or medians and interquartile ranges, as appropriate, and summarized in descriptive frequency tables. Data entry was performed using Microsoft Excel (Microsoft Corporation), and statistical analysis was conducted using the SPSS version 22.0 (SPSS Inc., Chicago, IL, United States).
RESULTS
During the study period, a total of 36 patients with blunt TBPI were included, of whom the majority were male (94.4%), and the mean age was 28.6 years (Figure 1 and Table 1). The fluctuation in TBPI frequency from 2010 to 2024 is shown in Figure 2. Traffic-related accidents, particularly motor vehicles (41.7%) and motorcycle crashes (13.9%), were the most common mechanism of injury. The mean ISS was 13.7 ± 7.3, the Revised Trauma Score was 7.4 ± 1.2, and the Trauma and Injury Severity Score was 0.96 ± 0.10. More than half of patients had pan-brachial plexus injury (52.8%), while upper and lower TBPI were seen in 30.6% and 16.7% of cases, respectively. Figures 3 and 4 show examples of MRI and intraoperative findings in two patients with TBPI. Anatomically, the most frequently affected region was the nerve root (55.6%), followed by the trunk (19.4%). More than half of the injuries (52.8%) occurred on the right side. Notably, two patients had nerve root and cord injuries, and two patients had nerve root and branch injuries. The chest (41.7%) was the most frequently associated injured region, followed by the abdomen (13.9%) and neck (11.1%). Upper limb fractures, frequently associated with TBPI, involved the humerus (16.7%) and ulna (11.1%), while other injuries included clavicle (16.7%), rib (13.9%), and spinal fractures (13.9%). Dislocation of the shoulder and elbow was found in 11.1% and 2.8% cases, respectively. Nearly half of the patients (47.2%) underwent spine MRI.
Figure 3 The examination results during the surgical procedure.
A: Orange arrow, pointing to the neck of the patient, the blue arrow pointing to the right shoulder, the black arrow pointing to the right clavicle, which is divided to expose the neurovascular of the brachial plexus and the axillary artery and vein. The three white arrows show the complete transaction of the nerve at the level of the cords of the brachial plexus; B: Proximal auxiliary artery with the repair process and vascular clamp on the proximal and distal ends for control; C: Axillary vein after repair.
Figure 4 Magnetic resonance imaging shows brachial plexus with evidence of significant subcutaneous oedema noted along the right lower cervical and shoulder regions with irregular soft tissue hematoma (arrow) along the inferior cervical region extending into the right supraclavicular and right axillary region displacing and partially entrapping the trunks of ipsilateral brachial plexus which appears relatively thickened with abnormal high T2WI signal intensity.
Underlying brachial plexus injury cannot be excluded and might be masked by the soft tissue hematoma.
Table 1 Descriptive analysis of traumatic brachial plexus injury (n = 36), n (%)/mean ± SD/median (interquartile range).
Table 2 outlines the management and outcomes of patients with TBPI, focusing on motor and sensory recovery, interventions, and long-term functional outcomes. Based on the Sunderland classification, most patients sustained severe injuries, with fifth-degree and third-degree (27.8% each) injuries being the most common. Post-injury assessment using the BMRC motor scale revealed complete paralysis (M0) in 25% of cases. In comparison, 8.3% exhibited only trace contractions (M1), a finding that persisted in long-term follow-up. Similarly, the sensory scale evaluations showed no sensation (S0) in 13.9% of patients at both the initial post-injury assessment and the long-term follow-up. Overall, motor and sensory functions remained markedly impaired in most patients, indicating the challenging prognosis of TBPI, particularly in severe cases.
Table 2 Management and outcome of traumatic brachial plexus injury, n (%)/median (interquartile range).
Most cases were managed conservatively (88.9%), with only 11.1% requiring surgical intervention. Among the operative cases, two patients underwent a modified Oberlin procedure, which involved an ulnar nerve transfer to the motor branches of both the biceps and brachialis muscles. Intubation and orthopedic interventions were needed in 27.8% of patients, while 16.7% required vascular repair. The median ICU stay was 3.5 days, and the overall hospital length of stay was 10.5 days. None of the patients died during hospitalization. The median follow-up duration was 1484 days. Long-term outcomes varied: 66.7% of patients showed no recovery, 13.9% had partial improvement, and 19.4% achieved full recovery. The median time to any observed functional improvement was 7 months (interquartile range: 6-10 months) from injury. Among those with partial or full recovery, initial improvements in muscle strength were typically noted at a median of 6 months, while meaningful recovery in sensation or coordinated upper limb movement occurred by 9 months post-injury.
Table 3 shows a comparison of TBPI stratification by injury type. The two groups were comparable in age, mechanism of injury, management, and long-term outcomes, except for the injury severity score, which was significantly higher in patients with pan-plexus (16.4 ± 8.2 vs 10.8 ± 5.1; P = 0.02) than in those with upper/Lower TBPI. However, there was no significant difference based on anatomical location (Table 4).
Table 3 Comparison of traumatic brachial plexus injury stratification by injury type, n (%)/mean ± SD.
Few studies from the Middle Eastern region have examined the epidemiological profile and long-term outcomes of blunt TBPI[14-17]. The present study has several key findings: Most patients were young males. Traffic accidents accounted for most injuries. A systematic review and meta-analysis of severe adult TBPIs requiring surgical intervention found that 93% of patients were male, compared to 94.4% in our cohort. These findings are consistent with prior studies from other Asian countries[18-20], likely due to greater mobility among young adult males, which has a profound economic impact on patients and society through functional impairment. It has been reported that blunt TBPIs occur more frequently in unshielded vehicles (e.g., motorcycles and bicycles) compared to shielded motor vehicles, as the former provide less protection to riders and passengers[21]. Over half of the cases had pan-brachial plexus injuries (52.8% in our series), frequently accompanied by concomitant chest trauma. Severe nerve damage was common, predominantly at the root level. Conservative management was the mainstay of treatment, with surgical intervention infrequently employed. Long-term outcomes were often poor, with two-thirds of patients showing no functional recovery and only 16.7% achieving complete recovery.
These findings align with a systematic review by Kaiser et al[6], which reported a 53% prevalence for complete lesions, followed by upper plexus lesions (39%) and lower plexus injuries (6%). However, other studies have reported higher rates of complete TBPI up to 70%, with upper (15%) and extended upper TBPI (14%) being more frequent than in our cohort. In comparison, lower injuries accounted for only 1% of cases[8]. Notably, complete lesions typically result from either extreme traumatic forces or a combination of multiple forces during impact[22]. Another study reported upper injuries in 60% of patients, lower injuries in 22%, and pan-brachial plexus injuries in 16%[15].
In our study, the nerve root was the most frequently affected region of the brachial plexus. These findings align with a prior investigation assessing the diagnostic utility of MRI, which reported nerve root involvement in 68% of cases and trunk involvement in 63.6%[23]. The predominance of root-level injuries can be attributed to their increased vulnerability to mechanical stress, particularly in high-impact trauma such as road traffic accidents. Preganglionic injuries, often caused by severe traction forces, are prevalent in such scenarios due to the abrupt stretching or avulsion of nerve roots from the spinal cord[24]. Therefore, the anatomical and mechanical properties of the brachial plexus roots make them more susceptible to injury compared to the distal segments.
Earlier studies[25-27] have reported a broader spectrum of frequent concomitant injuries associated with TBPI. Boyle et al[2] reported that 94% of TBPI patients exhibited associated injuries, further underscoring the high prevalence of polytrauma in this patient population. However, these findings contrast with those reported by Sumarwoto et al[8], who documented a lower incidence of concomitant injuries. In their study, humeral shaft fractures were the most prevalent, followed by forearm and clavicle fractures.
Treatment for TBPI encompasses both conservative and surgical approaches. Initial management typically prioritizes conservative strategies to alleviate pain, preserve upper limb range of motion, strengthen functional musculature, and protect denervated dermatomes, thereby facilitating rehabilitation[9]. Consistent with this approach, most cases received conservative management. This could be attributed to the fact that we have included all patients with recorded TBPI regardless of management. Furthermore, the prevalence of low velocity infraclavicular plexus injuries, which are more likely to improve with nonoperative management, as corroborated by earlier studies[2,28], may also explain this finding. Notably, conservative management permits spontaneous recovery, particularly in postganglionic injuries[7]. Moreover, surgical intervention is considered when spontaneous recovery fails or root avulsion is highly suspected, especially in preganglionic injuries, where spontaneous recovery is uncommon[7,11]. Consequently, the decision for and timing of surgery necessitate individualized assessment[7,11]. Many factors play a crucial role in the success of surgical management. The appropriate time to decide on surgical intervention should not exceed three to six months from the incident, if the patient shows no clinical improvement and/or electrophysiological progression. The patient’s age at the time of surgery is a significant prognostic factor that should be considered alongside the delay between the accident and the surgical intervention. The results of reconstructing nerve ruptures in blunt brachial plexus injuries with nerve grafts are unreliable. Therefore, when surgically approaching patients with a blunt TBPI, nerve transfers will be the primary method for reconstruction. Nerve transfer has become the mainstay of surgical reconstruction for brachial plexus injuries. The aim is to restore the following upper-extremity functions in order: Elbow flexion, shoulder stability, abduction, and external rotation. In addition, reconstructing the long thoracic nerve should be considered. Nerve transfer donors utilized for reconstructing brachial plexus injuries are either intraplexal or extraplexal. Each has an advantage over the other. For instance, intra-plexal nerve donors provide predictable functional outcomes. However, extra-pleural nerve donors may be considered for treating more severe injuries[29].
In our cohort, surgery was required in only 11.1% of cases. In contrast, a recent retrospective study of 64 patients with TBPI reported a substantially higher surgical rate of 53.1%[30]. This relatively low rate likely reflects a combination of strict surgical selection criteria, preference for initial conservative management, and system-related factors such as early repatriation of expatriate patients, which may limit continuity of care and timely surgical planning. Nevertheless, advances in microsurgical techniques over recent decades have enhanced surgical outcomes, making it a preferable option in select scenarios[8]. Primary procedures include neurolysis, nerve grafting, and nerve transfer, with functional recovery achieved in approximately 61% of patients[15,31]. All surgically managed patients in our study underwent nerve transfer. However, if the primary procedure fails, secondary procedures such as tendon transfer, functional free muscle transplantation, and arthrodesis may be indicated[9].
Supporting this approach, a review from Qatar discussed various surgical approaches for managing global TBPI and their outcomes[32]. It emphasized nerve transfer as the optimal reconstructive strategy over alternatives, such as muscle or tendon transfer, based on a comparative analysis of donor-recipient nerve combinations and their functional outcomes. This is because reconstruction with nerve transfer elicits a stronger cortical response, which is reflected in the progression of rehabilitation therapy. Nerve transfer has the advantage over tendon transfers because a single nerve transfer can provide multiple functions. At the same time, a single tendon transfer will provide a single function around the joint[33].
In our study, post-injury motor scale assessments revealed that 55.5% of patients achieved good functional outcomes, defined as a BMRC grade of 3 or higher. In comparison, a retrospective study of 578 adult TBPI cases reported that graft repair yielded favorable outcomes in fewer than 50% on follow-up[34]. Nevertheless, persistent motor and sensory deficits in most cases underscore the challenging prognosis of TBPI, particularly in severe presentations. These findings contrast with an earlier analysis of 47 surgically managed TBPI patients, where only 29.8% achieved good functional outcomes[33]. This variation may be explained by differences in injury severity, patient selection, timing of intervention, and inclusion of both conservatively and surgically managed patients in our cohort, which may have influenced overall functional outcomes. In general, the surgical outcome of a nerve transfer depends on the number of fascicles in the donor nerves and their proximity to the target muscles. As a rule, the closer the nerve to the target muscle, the shorter the duration for nerve regeneration[29]. Notably, pan-plexal injuries and the utilization of intercostal or phrenic nerve transfers were associated with poorer results.
Functional recovery varied by injury pattern: Among surgical patients with C5-C6 injuries, 76.81% regained functional use of the limb after 3 years[31]. Martin et al’s systematic review recommends surgical intervention for blunt/stretch TBPI within 6 months post-injury[35]. The evidence underscores time to intervention as a modifiable factor that can significantly impact outcomes. Specifically, comparative studies have shown that patients undergoing surgical repair within 6 months achieve better motor and sensory recovery than those treated after this window, with delayed surgery associated with lower rates of functional restoration and higher levels of persistent disability. While a 3-month observation period to allow for potential spontaneous regeneration remains clinically prudent, expediting surgical intervention when indicated offers a practical means to optimize patient outcomes. Long-term functional outcomes in our cohort manifested as no recovery in 66.7% of cases, partial improvement in 16.7%, and full recovery in 16.7%, highlighting the need to identify candidates for early surgery to improve the likelihood of favorable results.
Suroto et al[36] reported that 23.4% of patients underwent intervention within 6 months post-injury, 76 patients between 6 and 12 months, and 300 patients beyond 12 months. Their study identified significant differences in Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Visual Analogue Scale pain assessments for complete BPI (C5-T1), as well as in shoulder abduction range of motion and muscle power for upper BPI (C5-C7). Post hoc analysis demonstrated that free functional muscle transfer significantly reduced DASH scores and alleviated pain compared with nerve transfer in complete BPI (C5-T1). In terms of functional outcome, 76.81% of surgical patients with C5-C6 injuries were able to regain limb function after 3 years[29]. It’s worth noting that papers exploring advanced surgical management in the Gulf region and the Middle East in general are scarce[32,37]. Reflecting the underdevelopment of reconstructive surgeries. This paper sheds light on this deficiency, which requires the attention of strategists to invest in the development of brachial plexus reconstruction and rehabilitation. Based on existing literature, three steps could guide clinicians considering management of TBPI and provide a pragmatic approach to support standardized and timely decision-making[3,38,39]: First: Initiate conservative management and closely monitor all patients for clinical and electrophysiological recovery within the first three to six months post-injury. This approach is particularly suitable for postganglionic or low velocity infraclavicular injuries, which demonstrated higher rates of spontaneous improvement in our cohort. However, for patients with confirmed root avulsion, delaying surgical intervention for 3-6 months is generally unnecessary. Early operative management is appropriate in such cases. An exception applies when a major vascular injury is associated with the brachial plexus trauma. In these circumstances, limb salvage and vascular stabilization take precedence. A period of delay may be justified to allow systemic stabilization following the inflammatory response as well as to permit maturation and stabilization of the vascular reconstruction before proceeding with definitive nerve surgery.
Second, during follow-up, assess for evidence of spontaneous motor or sensory recovery. If no meaningful improvement is observed by three to six months, or if early imaging and electrodiagnostic evaluation indicate root avulsion or severe preganglionic injury, escalate evaluation for surgical intervention. Third: For cases selected for surgery, nerve transfer should be prioritized as the reconstructive method of choice, aiming to restore elbow flexion first and then shoulder function. Surgical planning should account for patient age, extent and anatomical location of injury, and time from trauma to surgery, as these factors influence outcomes in our series.
Limitations
This study, while providing a unique description of the epidemiological pattern of TBPI in Qatar, is constrained by several limitations inherent to its retrospective observational design. The small sample size limits statistical power and generalizability, as the data were collected from a small country with a total population of 2.8 million. Moreover, the rarity of TBPI in adults should be considered. Furthermore, the lack of detailed clinical data, including presentation, anatomic injury findings (open or closed), and clinical course, limits deeper pathophysiological analysis. Critical data gaps exist regarding the proportions of supra- vs infraclavicular injuries, the extent of lesions in laceration injuries, and the nature of closed infraclavicular injuries. In addition, brachial plexus reconstruction in Qatar, using various nerve and tendon transfer methods, is still expanding and developing. This study underscores the importance of adopting advanced surgical strategies to manage brachial plexus injuries in the region. Given the retrospective nature of the study and the long study period, detailed protocol standardization and duration were not uniformly available. The study lacks information on severe TBPI cases deemed inoperable due to late presentation or the extent of the primary injury, as well as the timing from injury to intervention. Finally, Shorter follow-up was mainly due to repatriation of expatriate patients. Loss to follow-up was few (n = 4), likely for the same reason.
CONCLUSION
This study highlights the significant and frequently persistent functional deficits associated with TBPI. Conservative management constituted the primary treatment strategy; however, most patients exhibited persistent deficits. Motor recovery outcomes were particularly poor in one-fourth of patients with no muscle contraction and many failing to regain meaningful function. In contrast, sensory recovery was comparatively better, with a subset of patients achieving partial or normal sensation, underscoring differing patterns of neurological recovery. Surgical intervention was pursued in a minority of cases, using techniques such as nerve and tendon transfers, indicating the inherent complexity of managing TBPI. This highlights the crucial importance of early diagnosis, prompt intervention, multidisciplinary team, and ongoing rehabilitation. Future larger multicenter cohort studies are needed to validate findings, detect meaningful associations, identify predictors to optimize selection for early surgical management and to compare long-term quality-of-life and socioeconomic outcomes.
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