Management and outcome of blunt traumatic brachial plexus injuries in adult trauma patients: A retrospective study

Table 1 Descriptive analysis of traumatic brachial plexus injury (n = 36), n (%)/mean ± SD/median (interquartile range)

Variables	Value
Age (years)	28.6 ± 8.4
Males	34 (94.4)
Mechanism of injury
Motor vehicle crashes	15 (41.7)
Motorcycle/bike crashes	5 (13.9)
Fall from height	4 (11.1)
Fall of heavy object	4 (11.1)
Machinery	3 (8.3)
Pedestrian	1 (2.8)
Others	4 (11.1)
GCS ED	15 (3-15)
Injury Severity Score	13.7 ± 7.3
ISS	13 (9-17)
Revised Trauma Score	7.4 ± 1.2
TRISS	0.961 ± 0.105
Types of TBPI
Complete TBPI (pan-plexus)	19 (52.8)
Upper TBPI	11 (30.6)
Lower TBPI	6 (16.7)
Anatomical location of TBPI1
Nerve root	20 (55.6)
Trunk	7 (19.4)
Division	2 (5.6)
Cord	4 (11.1)
Branch	3 (8.3)
Side of injury
Right side	19 (52.8)
Left side	17 (47.2)
Concomitant injuries	30 (83.3)
Chest	15 (41.7)
Abdomen	5 (13.9)
Neck	4 (11.1)
Head	3 (8.3)
Fractures
Humerus	6 (16.7)
Clavicle	6 (16.7)
Ribs	5 (13.9)
Spine	5 (13.9)
Ulnar	4 (11.1)
Scapula	3 (8.3)
Radial	1 (2.8)
Dislocation
Shoulder	4 (11.1)
Elbow	1 (2.8)
Spine MRI	17 (47.2)
Head AIS	3.5 ± 2.1
Chest AIS	2.8 ± 0.9
Abdomen AIS	2.8 ± 0.8
Cervical spine AIS	2.1 ± 0.4
Lumbar spine AIS	2.0 ± 0.0
Thoracic spine AIS	2.0 ± 0.0
Upper extremity AIS	2.0 ± 0.0
Lower extremity AIS	2.4 ± 0.5

¹Two patients had nerve root and cord injury, and 2 patients had nerve root and branch injury.

TBPI: Traumatic brachial plexus injury; GCS ED: Glasgow Coma Scale at the emergency department; ISS: Injury Severity Score; AIS: Abbreviated injury; TRISS: Scale Trauma and Injury Severity Score.

Table 2 Management and outcome of traumatic brachial plexus injury, n (%)/median (interquartile range)

Variables	Value	Variables	Value
Sunderland classification		Ventilator days	1 (1-18)
Fifth-degree injury	10 (27.8)	ICU length of stay	3.5 (1-36)
Third-degree injury	10 (27.8)	Hospital length of stay	10.5 (1-89)
First-degree injury	8 (22.2)	Mortality	0 (0.0)
Fourth-degree injury	5 (13.9)	BMRC scale (long-term outcome)
Second-degree injury	3 (8.3)	Motor scale
BMRC (after injury)		M0 no contraction	9 (25.0)
Motor scale		M1 flicker (trace of contraction)	3 (8.3)
M0 no contraction	9 (25.0)	M2 active movement with gravity eliminated	3 (8.3)
M1 flicker (trace of contraction)	3 (8.3)	M3 active movement against gravity	8 (22.2)
M2 active movement with gravity eliminated	4 (11.1)	M4 active movement against gravity and resistance	9 (25.0)
M3 active movement against gravity	10 (27.8)	M5 normal (full) power	4 (11.1)
M4 active movement against gravity and resistance	7 (19.4)	Sensory scale
M5 normal (full) power	3 (8.3)	S0 no sensation	5 (13.9)
Sensory scale		S1 pain sensation	0 (0.0)
S0 no sensation	5 (13.9)	S2 pain and some touch sensation	5 (13.9)
S1 pain sensation	1 (2.8)	S3 pain and touch with no overreaction	4 (11.1)
S2 pain and some touch sensation	5 (13.9)	S3+ some two-point discrimination	12 (33.3)
S3 pain and touch with no overreaction	8 (22.2)	S4 normal sensation	10 (27.8)
S3+ some two-point discrimination	16 (44.4)	Long-term outcome
S4 normal sensation	1 (2.8)	No recovery	24 (66.7)
Intubation	10 (27.8)	Some improvement	5 (13.9)
Exploratory laparotomy	1 (2.8)	Full recovery	7 (19.4)
ORIF	10 (27.8)	Follow-up duration (days)	1484 (8-5620)
Repair of blood vessels	6 (16.7)
Management
Conservative	32 (88.9)
Surgery1	4 (11.1)

¹Two patients had undergone modified Oberlin procedure, where the ulnar nerve fascicle was transferred to the brachialis muscles’ motor branch and the median nerve fascicle was transferred to the biceps motor branch. Another patient had also modified Oberlin procedure where fascicles of flexor carpi radialis and flexor carpi ulnar was utilized to restore elbow flexion. Additionally, trapezius muscle transfer to the deltoid was performed to restore shoulder abduction. One patient had the right spinal accessory nerve transferred to right suprascapular nerve to restore shoulder abduction function as the first stage. On the second stage, the intercostal nerve was transferred to the musculocutaneous nerve.

ORIF: Open reduction and internal fixation surgery; ICU: Intensive care unit; BMRC: British Medical Council Scale assessment.

Table 3 Comparison of traumatic brachial plexus injury stratification by injury type, n (%)/mean ± SD

	Pan-plexus (n = 19)	Upper/Lower TBPI (n = 17)	P value
Age (years)	30.8 ± 9.2	26.1 ± 6.7	0.09
Mechanism of injury
Traffic-related	13 (68.4)	7 (41.2)	0.10 for all
Fall from height	1 (5.3)	3 (17.6)
Fall of heavy object	3 (15.8)	1 (5.9)
Machinery	2 (10.5)	1 (5.9)
Pedestrian	0 (0.0)	1 (5.9)
Others	0 (0.0)	4 (23.5)
Injury severity score	16.4 ± 8.2	10.8 ± 5.1	0.02
Management
Conservative	17 (89.5)	15 (88.2)	0.90
Surgery	2 (10.5)	2 (11.8)
Long-term outcome
No recovery	14 (73.7)	10 (58.8)	0.63
Some improvement	2 (10.5)	3 (17.6)
Full recovery	3 (15.8)	4 (23.5)

TBPI: Traumatic brachial plexus injury.

Table 4 Comparison of traumatic brachial plexus injury stratification by anatomical location, n (%)/mean ± SD

	Nerve root (n = 20)	Trunk (n = 7)	P value
Age (years)	29.2 ± 8.7	31.1 ± 9.7	0.62
Mechanism of injury
Traffic-related	11 (55.0)	3 (42.9)	0.44
Fall from height	3 (15.0)	0 (0.0)
Fall of heavy object	3 (15.0)	1 (14.3)
Machinery	1 (5.0)	1 (14.3)
Pedestrian	1 (5.0)	0 (0.0)
Others	1 (5.0)	2 (28.6)
Mean Injury Severity Score	15.0 ± 7.6	10.7 ± 4.0	0.20
Management
Conservative	17 (85.0)	6 (85.7)	0.96
Surgery	3 (15.0)	1 (14.3)
Long-term outcome
No recovery	17 (85.0)	4 (57.1)	0.20
Some improvement	1 (5.0)	2 (28.6)
Full recovery	2 (10.0)	1 (14.3)