Background Restoration of shoulder functions is important in brachial plexus injury (BPI). The functional outcomes of spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer by the anterior supraclavicular approach and the posterior approach is a matter of debate. This article aims to compare the outcomes of the shoulder functions by the SAN to the SSN transfer using the two approaches. Methods Retrospective data was collected in 34 patients who underwent SAN to SSN transfer from January 2016 to June 2018. Group A included 16 patients who underwent nerve transfers by anterior approach, and Group B included 18 patients who underwent nerve transfers by posterior approach. Functional outcomes were measured by grading the muscle power as per the British Medical Research Council (MRC) grading (graded as M) and the range of motions (ROM) of the shoulder at 6 months and 18 months. Results Early recovery was seen in group B with 7 patients (39%) showing M1 abduction power at 6 months as compared with one patient (6%) in group A . This difference was statistically significant (p value = 0.04). At 18 months, 10 patients (62%) in group A had good recovery (MRC grade ≥3), while 13 patients (72%) in group B had a good recovery. This difference was not found to be statistically significant (Fisher exact test p value = 0.71) There was no statistical difference in the outcomes of ROM in shoulder abduction, external rotation, and motor power at 18 months of follow-up. Conclusions Early recovery was observed in the posterior approach group at 6 months, however, there was no significant difference in the outcomes of shoulder functions in muscle power and ROM in the two groups at 18 months of follow-up.

Introduction: Permanent vascular access is an essential intervention in patients with advanced chronic kidney disease (CKD) and its success depends on various non-modifiable and modifiable factors. Considering the element of unpredictability and failure, we attempted to analyze various factors responsible for primary arteriovenous fistula (AVF) failure in presumed high-risk groups. Materials and Methods: We conducted an observational study of newly created AVFs at a tertiary referral government hospital in Eastern India between January 2014 and June 2015. All adult CKD patients undergoing AVF creation were included. Primary AVF failure was assessed at 12 weeks and total follow-up was 24 weeks in presumed high-risk groups of females, patients aged ≥65 years and those with diabetes mellitus. Results: Female gender was at a higher risk of primary AVF failure if aged ≥65 years ( P = 0.0026), second AVF creation ( P = 0.03), loupe magnification not used ( P = 0.03), arterial plaque ( P = 0.028), absent immediate thrill, and with radiocephalic AVF ( P = 0.02). Absent immediate thrill (<0.0001) and AVF size ≤5 mm ( P = 0.002) were important independent risk factors for primary failure. Diabetes or elderly age did not have additional risk, except with uncontrolled hypertension and female gender. Conclusion: Female gender was at a higher risk of poor unassisted AVF patency if their age was ≥65 years, had second AVF creation, loupe magnification not used or if arterial plaque was present. An absence of thrill immediately or at 24 hours or an AVF diameter ≤5 mm were independent intraoperative factors for poor outcome. On the contrary, diabetics, elderly males and intimal thickness were essentially noncontributors for AVF failure, except in few subsets.

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