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High-resolution ultrasound of the supraclavicular brachial plexus—can it improve therapeutic decisions in patients with plexus trauma?

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Abstract

Patients with major traumatic brachial plexus lesions benefit from early surgery, but they are seldom isolated by today’s diagnostic workup. Subjects with ambiguous findings after such workups usually undergo a trial of conservative treatment and those without improvement delayed surgery. Our study focuses on this problem. Hence, the purpose of this study was to evaluate the impact of high-resolution ultrasound (HR-US) on patient recruitment for non-delayed surgery. Twelve patients after blunt shoulder trauma and standardized HR-US assessment who underwent plexus surgery were included in this prospective observational study. Thereby, a total of 168 plexus elements were evaluated. All findings were compared to electrophysiological data if available and tested statistically against the gold-standard, i.e., surgical validation. Major plexus lesions were correctly detected by HR-US in nine patients (20 plexus elements). In two patients (five plexus elements), the lesion was underestimated by HR-US in relation to the gold standard (surgical inspection). Our analysis showed a high positive (1.0) and an acceptable negative predictive value (0.92) for the grading of traumatic plexus lesions with HR-US. Based on HR-US findings alone, 9 of 11 patients with objective major lesions would have undergone early surgery. In conclusion, HR-US proved a valuable tool for the triage of patients with traumatic lesions into surgical and non-surgical candidates.

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Authors and Affiliations

  1. Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Hannes Gruber, Bernhard Glodny, Gerd Bodner & Siegfried Peer

  2. Department of Traumatology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Florian Kamelger

  3. Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Klaus Galiano

  4. Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Heribert Hussl

  5. Department of Anatomy, Histology and Embryology, Division of Clinical-Functional Anatomy, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Florian Kamelger

Authors
  1. Hannes Gruber
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  2. Bernhard Glodny
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  3. Klaus Galiano
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  4. Florian Kamelger
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  5. Gerd Bodner
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  6. Heribert Hussl
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  7. Siegfried Peer
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Correspondence to Hannes Gruber.

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Gruber, H., Glodny, B., Galiano, K. et al. High-resolution ultrasound of the supraclavicular brachial plexus—can it improve therapeutic decisions in patients with plexus trauma?. Eur Radiol 17, 1611–1620 (2007). https://doi.org/10.1007/s00330-006-0464-2

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  • DOI: https://doi.org/10.1007/s00330-006-0464-2

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