Traumatic Brachial Plexus Injuries: HULS Protocol of Management.

Authors

  • Saeed Ahmad Classified Orthopedic Surgeon, Hand and Upper Limb, Surgery (HULS) Center CMH Lahore Medical College
  • Khalid Masood Head of Department, HULS Center CMH Lahore Medical College
  • Hafiz Muhammad Kashif Shafi Classified Orthopedic Surgeon, Hand and Upper Limb, Surgery (HULS) Center CMH Lahore Medical College
  • Khalid Zulfiqar Qureshi Classified Orthopedic Surgeon, Hand and Upper Limb, Surgery (HULS) Center CMH Lahore Medical College
  • Belal Saadat Classified Orthopedic Surgeon, Hand and Upper Limb, Surgery (HULS) Center CMH Lahore Medical College
  • Karam Rasool Basra Classified Orthopedic Surgeon, Hand and Upper Limb, Surgery (HULS) Center CMH Lahore Medical College

Keywords:

Brachial Plexus, Functional Outcome, Injury, Muscle transfer, Nerve.

Abstract

Objective:To determine the functional outcome of traumatic brachial plexus injuries managed in our institution with our own designated treatment protocol( Hand and Upper Limb Surgery-HULS).

Methods:This descriptive study was conducted in Hand and Upper Limb Surgery center CMH Lahore Medical College from 12th October 2012 to 12th October 2020.Patients of either gender and all ages with traumatic brachial plexus injuries fulfilling the inclusion criteria were assessed and treated with our own designitated algorithm (HULS protocol). Post treatment functional results were gradded as excellent, good, fair and poor.

Results:The total number of patients in our study were 336.Mean age was 32.72 ± 5.58 years.Male patients were 316(94%) and female 20(5.9%). Right sided brachial plexus injury was noted in 245(72.9%) patients and left in 91(27%).Mean follow up peroid was 18 months(range 12 to 23 months).Post treatment functional results were excellent in 16(4.7%) patients, good in 159(47.3%),fair in 121(36%) and poor in 40(11.9%) patients.

Conclusion:Traumatic brachial plexus injuries managed as per HULS protocol resulted in excellent and good functional outcome in majorityof our patients.We found this protocol relevant, applicable and feasible with improved clinical decision making, patient care and outcomes in traumatic brachial plexus injuries.

References

Sakellariou VI, Badilas NK, George A Mazis GA, Stavropoulos NA, Helias HK, et al. Brachial plexus injuries in adults: Evaluation and diagnostic approach. International Scholarly Research Notices.2014;345-356.

Shin AY, Spinner RJ, Steinmann SP, Bishop AT. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg.2005;13(6):382-96.

Narakas AO. The treatment of brachial plexus injuries. Int Orthop. 1985;9(1):29-36.

Kaiser R, Mencl L, Haninec P. Injuries associated with serious brachial plexus involvement in polytrauma patients requiring surgical repair. Injury. 2014;45(1):223-6.

Jan AU, Cheema TA, Ahmad S, Shafiq M, Hussain B, Ullah F.Outcome of dynamic compression plate with dorsal radial sliding graft technique for wrist arthrodesis in brachial plexus injury patients.J Ayub Med Coll Abbotabad.2019;31(2):141-145.

Miller C, Cross J, Power DM, Kyte D, Jerosch-Herold C.Development of a core outcome set for traumatic brachial plexus injuries (COMBINE): Study protocol. BMJ Open. 2019;9(6):146-152.

Shanina E, Liao B, Smith RG.Brachial Plexopathies: Update on treatment.Curr Treat Options Neurol. 2019;21(5):24-30.

Tung TH, Mackinnon SE. Brachial plexus injuries. Clin Plast Surg.2003 Apr;30(2):269-87.

Chaitanya D, Kazuteru D, Yasunori H, Soutetsu S, Yuki F, Takehiko T,et al. Outcome of surgical reconstruction after traumatic total brachial plexus palsy. J Bone Joint Surg. 2013;95(16):1505-12.

Bhandari PS, Maurya S. Recent advances in the management of brachial plexus injuries. Indian J Plast Surg. 2014;47(2): 191-198.

Noland SS, Bishop AT,Spinner RJ,Shin AY.Adult traumatic brachial plexus injuries.J Am Acad Orthop Surg. 2019;27(19):705-716.

Veronesi BA,Rodrigues MB,De Sambuy MT,Macedo RS,Cho AB,De Rezende MR.Use of Magnetic Resonance Imaging to diagnose brachial plexus injuries.Acta Ortho Bras.2018;26(2):131-134.

Martin E, Senders JS, DiRisio AC, Smith TR, Broekman ML. Timing of surgery in traumatic brachial plexus injury: A systematic review. J Neurosurg.2018;313-320.

Shelley SN, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries.J Am Acad Orthop Surg 2019;27: 705-716.

Dubuisson AS, Kline DG: Brachial plexus injury: A survey of 100 consecutive cases from a single service. Neurosurgery.2002; 51:673-683.

Samii A, Carvalho GA, Samii M. Brachial plexus injury: Factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion. J Neurosurg.2003; 98:307-312.

Bentolila V, Nizard R, Bizot P, Sedel L. Complete traumatic brachial plexus palsy: Treatment and outcome after repair. J Bone Joint Surg Am.1999; 81:20-28.

Narakas A. Indications and results of direct surgical treatment in lesions caused by stretching of the brachial plexus. Indications for direct surgical treatment [in French]. Rev Chir Orthop Reparatrice Appar Mot.1977; 63:88-106.

Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R: Quality of life measurement: Bibliographic study of patient assessed health outcome measures. BMJ.2002; 324:1417.

Wright JG. Outcomes research: What to measure. World J Surg.1999; 23:1224-1226.

Sinha S, Khani M, Mansoori N, Midha R. Adult brachial plexus injuries: Surgical strategies and approaches. Neurol India.2016;64:289-96.

Kachramanoglou C, Carlstedt T, Koltzenburg M, Choi D. Long-term outcome of brachial plexus reimplantation after complete brachial plexus avulsion injury. World Neurosurg. 2017;103: 28-36.

Ahmed-Labib M ,Golan JD, Jacques L.Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery.2007; 61:1016-1023.

Loeser JD, Ward AA Jr, White LE Jr: Chronic deafferentation of human spinal cord neurons. J Neurosurg.1968; 29:48-50.

Parry CB.Pain in avulsion lesions of the brachial plexus. Pain.1980; 9:41-53.

Choi PD, Novak CB, Mackinnon SE, Kline DG. Quality of life and functional outcome following brachial plexus injury. J Hand Surg [Am].1997;22:605-612.

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Published

2021-01-22

Conference Proceedings Volume

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Original Articles

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Traumatic Brachial Plexus Injuries: HULS Protocol of Management. (2021). Journal of Pakistan Orthopaedic Association, 32(04), 206-210. https://jpoa.org.pk/index.php/upload/article/view/484

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