Blunt traumatic brachial plexus injuries in a northern rural US setting: increased likelihood in unshielded motor-powered crashes

Leonard, Samantha L.; Woehrle, Tobias; Nikizad, Hooman; Vearrier, Jared; Odean, Marilyn J; Renier, Colleen M.; Bollins, John P.; Eyer, Steven D.

doi:10.1136/tsaco-2020-000558

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Moreover, Leonard et al also reported that the number of blunt traumatic brachial plexus injuries (BTBPIs) involving unshielded vehicles was significantly higher than those involving a shielded vehicle, especially in rural regions, as unshielded vehicles gave less protection to the drivers and passengers. 29 In relation to the mode of injury due to “high speed” motorized accident, Rhee et al found that all patients had associated injuries in addition to their spinal cord injury and brachial plexus injury. The most common associated injuries were to the head or face, loss of consciousness, and spine fractures (especially cervical spine fractures).…”

Section: Discussionmentioning

confidence: 99%

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

Suroto

Antoni

Siyo

et al. 2021

J Reconstr Microsurg

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Background Brachial plexus injuries (BPI) cause severe physical disability and major psycho-socioeconomic burden. Although various countries have reported BPI incidence, the data from Indonesia as the fourth most populated country in the world remains unknown. We aim to assess the distribution of traumatic BPI, patients' characteristics, and treatment modalities in Indonesia. Methods A retrospective investigation was performed comprising 491 BPI patients at a tertiary referral hospital in Indonesia from January 2003 to October 2019. Demographic and outcomes data were retrieved from medical records. Results The average BPI patients' age was 27.3 ± 11.6 years old, with a male/female ratio of 4.6:1. Motorcycle accidents caused the majority (76.1%) of all BPI cases. Concomitant injuries were present in 62.3% of patients, dominated by fractures (57.1%) and brain injuries (25.4%). BPI lesion type was classified into complete (C5-T1, observed in 70% patients), upper (C5-C6, in 15% patients), extended upper (C5-C7, in 14% patients), and lower type (C8-T1, in 1% patients). The average time to surgery was 16.8 months (range 1–120 months), with the majority (76.6%) of the patients was operated on six months after the trauma. Free functional muscle transfer (FFMT) was the most common procedure performed (37%). We also analyzed the functional outcomes (active range of motion (AROM) and muscle power), DASH (Disabilities of the Arm, Shoulder, and Hand) score, and VAS (Visual Analogue Scale) across four most frequent procedures involving nerve reconstruction (FFMT, nerve transfer, external neurolysis, and nerve grafting). We found that FFMT was significantly better than nerve transfer in terms of DASH score and VAS (p = 0.000 and p = 0.016, respectively) in complete BPI (C5-T1). Moreover, we also found that nerve grafting resulted in a significantly better shoulder abduction AROM than nerve transfer and external neurolysis in extended upper BPI (C5-C7) (p = 0.033 and p = 0.033, respectively). Interestingly, no significant differences were observed in other measurements. Conclusion This study provides an overview of traumatic BPI patients in a single tertiary trauma center in Indonesia, expressing the profile of their characteristics and functional outcomes after surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

Suroto

Antoni

Siyo

et al. 2021

J Reconstr Microsurg

View full text Add to dashboard Cite

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A Conflict Measures-Based Extreme Value Theory Approach to Predicting Truck Collisions and Identifying High-Risk Scenes on Two-Lane Rural Highways

Geng

Cao

et al. 2022

Sustainability

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Collision risk identification and prediction is an effective means to prevent truck accidents. However, most existing studies focus only on highways, not on two-lane rural highways. To predict truck collision probabilities and identify high-risk scenes on two-lane rural highways, this study first calculated time to collision and post-encroachment time using high-precision trajectory data and combined them with extreme value theory to predict the truck collision probability. Subsequently, a traffic feature parameter system was constructed with the driving behavior risk parameter. Furthermore, machine learning algorithms were used to identify critical feature parameters that affect truck collision risk. Eventually, extreme value theory based on time to collision and post-encroachment time incorporated a machine learning algorithm to identify high-risk truck driving scenes. The experiments showed that bivariate extreme value theory integrates the applicability of time to collision and post-encroachment time for different driving trajectories of trucks, resulting in significantly better prediction performances than univariate extreme value theory. Additionally, the horizontal curve radius has the most critical impact on truck collision; when a truck is driving on two-lane rural highways with a horizontal curve radius of 227 m or less, the frequency and probability of collision will be higher, and deceleration devices and central guardrail barriers can be installed to reduce risk. Second is the driving behavior risk: the driving behavior of truck drivers on two-lane rural highways has high-risk, and we recommend the installation of speed cameras on two-lane rural roads to control the driving speed of trucks and thus avoid dangerous driving behaviors. This study extends the evaluation method of truck collisions on two-lane rural highways from univariate to bivariate and provides a basis for the design of two-lane rural highways and the development of real-time dynamic warning systems and enforcement for trucks, which will help prevent and control truck collisions and alleviate safety problems on two-lane rural highways.

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Brachial Plexus Injury Surgical Service in Time of Coronavirus Disease 2019 Pandemic Experience from a Single Tertiary Orthopaedic Hospital in Indonesia

Hadinoto

Sumarwoto

Trapsilantya

2021

Open Access Maced J Med Sci

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BACKGROUND: Brachial plexus injury (BPI) is one of the most devastating nerve injuries to the extremities. BPI in adults is an increasingly common clinical problem due to road traffic accident. Injury patterns, the timing of surgery, priority on the recovery of function, and patient’s understanding about the expectations of the prognosis are things that are important to consider before deciding on surgical management. The coronavirus pandemic coronavirus disease 2019 (COVID-19) has significantly affected all sectors, one of which is a surgical practice both in terms of medical personnel and equipment, also patient perceptions of hospital services. AIM: This study will analyze epidemiological data on BPI patients who underwent surgery during the COVID-19 pandemic. METHODS: A retrospective descriptive study of BPI profile in Prof. Soeharso Orthopedic Hospital before (2019) and during (2020) the COVID-19 pandemic. Demographic data, the total number of surgery, type of surgical procedure, and patient origin were collected. We compared to the same period in 2019 before pandemic started. RESULTS: In the data obtained from patients treated or undergoing BPI surgery before pandemic (March 1, 2019 to December 31, 2019) and during the pandemic (March 1, 2020 to December 31, 2020), Indonesia first confirms case was on March 2, 2020, until today. There were 51 and 43 cases, respectively. Panplexal type before the pandemic there were 27 patients (52%), and during the pandemic were 20 patients (46%), the upper type before: during the pandemic was 24 (48%): 23 (54%), and lower type 0 cases. Primary reconstruction before: during the pandemic was 26 (55%): 27 (62%) case, and secondary reconstruction before: during the pandemic was 25 (49%): 16 (38%) case, respectively. CONCLUSION: COVID-19 pandemic has no significant effect in the term of the number of BPI surgery performed. Better outcome in BPI surgery is influenced by the timing of the operation, therefore primary reconstruction remains the main choice for BPI patients with safety concern or health protocols. Pre-operative screening applied in our hospital includes laboratory examination, chest radiograph, and polymerase chain reaction swab test. Surgical personnel using personal protective equipment such as protective suit, face shield, google, shoes and medical mask during the COVID-19 pandemic. Patients with significant axon loss and limited clinical recovery are considered “urgent”, as surgery should be performed within 6 months or sooner (depending upon the distance to recipient’s muscle) to avoid irreversible muscle atrophy and degradation of motor endplates.

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Blunt traumatic brachial plexus injuries in a northern rural US setting: increased likelihood in unshielded motor-powered crashes

Cited by 3 publications

References 9 publications

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

A Conflict Measures-Based Extreme Value Theory Approach to Predicting Truck Collisions and Identifying High-Risk Scenes on Two-Lane Rural Highways

Brachial Plexus Injury Surgical Service in Time of Coronavirus Disease 2019 Pandemic Experience from a Single Tertiary Orthopaedic Hospital in Indonesia

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