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Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents

Authors
  • Kaiser, Radek1
  • Waldauf, Petr2
  • Haninec, Pavel1
  • 1 Hospital Kralovske Vinohrady, Charles University, Third Faculty of Medicine, Department of Neurosurgery, Srobarova 50, Prague, 100 34, Czech Republic , Prague (Czechia)
  • 2 Hospital Kralovske Vinohrady, Charles University, Third Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine, Prague, Czech Republic , Prague (Czechia)
Type
Published Article
Journal
Acta Neurochirurgica
Publisher
Springer-Verlag
Publication Date
Feb 03, 2012
Volume
154
Issue
7
Pages
1293–1297
Identifiers
DOI: 10.1007/s00701-012-1291-7
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundBrachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents.MethodsA total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively (1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail.ResultsTraffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper, 22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents (63.2%) followed by car accidents (23.5%), bicycle accidents (10.7%) and pedestrian collisions (3.1%) (p < 0.001). Patients involved in car accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (p < 0.001). Lower plexus palsy was significantly increased in patients after car accidents (9.3%, p < 0.05). In the two main groups (car and motorcycle accidents), significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%).ConclusionStudy results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the potential of a brachial plexus injury after serious traffic accidents and to examine both upper extremities in detail even if some motor function is preserved.

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