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Traumatic brachial plexus injury: a study of 510 surgical cases from multicenter services in Guangxi, China

  • Original Article - Peripheral Nerves
  • Published:
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Abstract

Background

Traumatic brachial plexus injuries are severe lesions, and the incidence of these injuries has been increasing in recent years.

Methods

The clinical data of 510 operated patients with brachial plexus injury recruited from 74 hospitals in Guangxi from 2004 to 2016 were retrospectively studied.

Results

Our study included 447 males and 63 females, with an average age of 29.04 years. Traffic accidents were the most common cause of injury (64.71%), especially motorcycle accidents. Closed injuries accounted for 88.24% of cases, and 83.53% of patients had associated injuries, the most common of which were fractures (76.27%). The preoperative predictive value of root injury of MRI and CT was 74.71% and 71.28%, respectively. 44.71% of patients underwent an initial operation within 6 months after the trauma. Regarding the surgery, neurolysis alone, brachial plexus reconstruction, and free functioning gracilis graft accounted for 16.67%, 75.50%, and 4.51%, respectively. A total of 415 patients were followed up with an average time of 47.95 (25–68) months, and anxiety or depression were found among 81.20% of them. Two hundred seventy-six patients suffered from nerve pain, with mild pain present in 67.03% of patients. Additionally, 347 patients were followed up for more than 3 years, 76.81% of patients with C5-C6 injury recovery to useful function, and the procedure of neurolysis alone demonstrated the best efficacy (79.45%).

Conclusions

Brachial plexus injury is still a challenging trauma for surgeons, and traffic accidents are the dominant cause. Timely and effective surgery is important for functional limb recovery.

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Abbreviations

BPI:

Brachial plexus injury

BP:

Brachial plexus

MRI:

Magnetic resonance imaging

CT:

Computed tomography

VAS:

Visual analog scale

LSUMC:

Louisiana State University Medical Center

NAP:

Nerve action potential

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Disclaimer

The funders had no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the manuscript.

Funding

This study was supported by funds from the Natural Science Foundation of Guangxi, China (2015GXNSFCA1598011-5) and by the Shanghai Key Laboratory of Peripheral Nerve and Microsurgery (17DZ2270500).

Author information

Authors and Affiliations

  1. Department of Orthopedic Trauma and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China

    Guang-Yao Li, Ming-Qiang Xue, Jing-Wei Wang, Xiang-Yong Zeng, Jun Qin & Ke Sha

Authors
  1. Guang-Yao Li
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  2. Ming-Qiang Xue
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  3. Jing-Wei Wang
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  4. Xiang-Yong Zeng
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  5. Jun Qin
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  6. Ke Sha
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Corresponding author

Correspondence to Ke Sha.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

Not applicable.

Ethical approval

First Affiliated Hospital of Guangxi Medical University Ethical Review Committee, 2018 (KY-E-047).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

The authors report an impressive series of 510 patients with brachial plexus injuries operated on over a period of 12 years. The authors were able to collect follow-up data on 415 patients followed for more than two years. The authors use a number of techniques to repair the brachial plexus. A minority of patients could be treated with simple neurolysis. The majority of patients had either nerve grafts or nerve transfers. A few patients had tendon transfers. Their technical results were very impressive. It should be noted that despite the excellent technical results, 2/3 of the patients reported persistent pain and more than 80% of the patients reported persistent anxiety and depression. These findings indicate that despite surgical advances, we have a long way to go in treating patients with significant brachial plexus injuries.

Allan Friedman

NC, USA

An interesting epidemiological study of hospital admitted and treated brachial plexus injuries in China.

Michel Kliot

CA, USA

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Li, GY., Xue, MQ., Wang, JW. et al. Traumatic brachial plexus injury: a study of 510 surgical cases from multicenter services in Guangxi, China. Acta Neurochir 161, 899–906 (2019). https://doi.org/10.1007/s00701-019-03871-y

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  • DOI: https://doi.org/10.1007/s00701-019-03871-y

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