PMID- 38313427 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240206 IS - 0972-978X (Print) IS - 0972-978X (Electronic) IS - 0972-978X (Linking) VI - 51 DP - 2024 May TI - Outcomes of surgically managed adult traumatic brachial plexus injuries in an upper-middle-income country. PG - 66-72 LID - 10.1016/j.jor.2024.01.006 [doi] AB - BACKGROUND: Traumatic brachial plexus injuries (TBPIs) are debilitating and complex to treat. The last five decades have seen advances in surgical management, and consequently improved functional outcomes in patients with these injuries. There is limited data available describing the outcomes of surgically managed TBPIs within the South African context. This study aimed to identify the common causes of injury, injury characteristics, and functional outcomes of surgically managed patients with TBPIs. METHODS: We conducted a retrospective chart review of all adult patients that underwent surgery for TBPIs over a period of ten years at a specialised hand unit in South Africa. The minimum follow-up period was one year. Patient demographic details, injury characteristics and functional outcomes were collected. Statistical analysis was performed to determine factors associated with functional outcomes. A good functional outcome for recovery was defined as a Medical Research Council (MRC) grade of three or more for the affected elements of the plexus at the most recent follow-up. RESULTS: Forty-seven patients of median age 32 years were included in the final analysis. Most patients were male (87.2 %). The majority of patients were injured in motor vehicle accidents (MVAs) or from penetrating stab wounds (48.9 % and 38.3 % respectively). The median pre-operative MRC grade of the affected elements of the brachial plexus was 0.0, and post-operatively was 2.0. Fourteen patients (14 of 47, 29.8 %) had a good outcome and 33 had a poor outcome (33 of 47, 70.2 %). There was no difference in outcome comparing penetrating injury mechanisms to closed traction or blunt injuries, (p = 0.386, OR 1.75, 95 % CI 0.49-6.20). All patients with pan-plexal injuries had a poor outcome (15 of 33, 46 %). All patients who received intercostal (6 of 33, 18 %) or phrenic nerve transfers (3 of 33, 9 %) had a poor outcome. CONCLUSION: Adult traumatic BPIs in this South African sample typically presented more than two months after injury and were comprised of a high proportion of penetrating injuries. Just under a third of surgically managed patients had a good outcome. Pan plexal injuries have uniformly poor outcomes. We recommend early referral for all TBPIs to a unit that manages BPI to improve outcomes. CI - (c) 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved. FAU - Lunga, Henry AU - Lunga H AD - Department of Orthopaedic Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road, Umkumbaan, Durban, 4091, South Africa. AD - Department of Orthopaedic Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Clinical Medicine, 719 Umbilo Road, Umbilo, Berea, Durban, 4001, South Africa. FAU - O'Connor, Megan AU - O'Connor M AD - Department of Orthopaedic Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road, Umkumbaan, Durban, 4091, South Africa. AD - Department of Orthopaedic Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Clinical Medicine, 719 Umbilo Road, Umbilo, Berea, Durban, 4001, South Africa. FAU - Rocher, Antoine Gl AU - Rocher AG AD - Department of Orthopaedic Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road, Umkumbaan, Durban, 4091, South Africa. AD - Department of Orthopaedic Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Clinical Medicine, 719 Umbilo Road, Umbilo, Berea, Durban, 4001, South Africa. FAU - Marais, Leonard C AU - Marais LC AD - Department of Orthopaedic Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Clinical Medicine, 719 Umbilo Road, Umbilo, Berea, Durban, 4001, South Africa. LA - eng PT - Journal Article DEP - 20240110 PL - India TA - J Orthop JT - Journal of orthopaedics JID - 101233220 PMC - PMC10831236 OTO - NOTNLM OT - Adult OT - Brachial plexus OT - Injury OT - Outcome OT - Traumatic EDAT- 2024/02/05 06:42 MHDA- 2024/02/05 06:43 PMCR- 2025/05/01 CRDT- 2024/02/05 04:42 PHST- 2023/07/04 00:00 [received] PHST- 2024/01/07 00:00 [revised] PHST- 2024/01/09 00:00 [accepted] PHST- 2025/05/01 00:00 [pmc-release] PHST- 2024/02/05 06:43 [medline] PHST- 2024/02/05 06:42 [pubmed] PHST- 2024/02/05 04:42 [entrez] AID - S0972-978X(24)00006-0 [pii] AID - 10.1016/j.jor.2024.01.006 [doi] PST - epublish SO - J Orthop. 2024 Jan 10;51:66-72. doi: 10.1016/j.jor.2024.01.006. eCollection 2024 May.