Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: systematic review and meta-analysis

Abstract

The literature describing epidemiology, etiology, and types of serious brachial plexus injuries (BPIs) is sparse. The aim of this review was to investigate the epidemiological and etiopathogenetical data of serious BPIs undergoing surgical reconstruction. A systematic search was conducted from January 1985 to December 2017. All studies that reported data about prevalence of specific types and causes of BPIs in adults treated surgically were included and cumulatively analyzed. Ten studies including 3032 patients were identified. The pooled prevalence of closed BPIs was 93% (95% CI: 87-97%), lacerations accounted for 3% (95% CI: 1-6%), and gunshot wounds (GSWs) for 3% (95% CI: 0-7%). The prevalence of male patients was 93% (95% CI: 90-96%) and female cases 7% (95% CI: 4-10%). The most common cause of closed BPI was motorcycle accidents with 67% (95% CI: 49-82%) prevalence followed by car crashes with 14% (95% CI: 8-20%). Other causes were rare. Ninety percent (95% CI: 78-98%) of patients suffered from a supraclavicular or combined supra-/infraclavicular trauma, while 10% (95% CI: 2-22%) from isolated infraclavicular injury. The prevalence of complete lesions was 53% (95% CI: 47-58%) followed by upper plexus lesion with 39% (95% CI: 31-48%) and lower plexus injury with 6% (95% CI: 1-12%). This meta-analysis demonstrates that the typical patient suffering from severe BPI is a male after motorcycle accident with closed supraclavicular injury causing complete or slightly less commonly upper plexus palsy. Lacerations and GSWs of brachial plexus are rare.

Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

“…Complete injuries of brachial plexus are quite common during traumatic lesions (53%). Nevertheless, the upper structures are more affected than lower [5].…”

“…Indeed, in the epidemiology of the etiology of isolated BPIs, traumatic events remain the main cause of injury [49]. Usually, male subjects of working age are involved in traumatic BPIs, with a male/female ratio of 13.3:1 [5].…”

“…Most of these injuries determine relevant motor and sensory impairments of the upper limb, with disability and functional limitations [4]. Their etiology is different and could be related to several direct and indirect causes [5]. According to the anatomical extension of the injury and to the degree of nerve involvement, different therapeutic approaches are needed in order to obtain a clinical restoration of functions, although it is not always possible, and some limitations could be persistent.…”

Ultrasound imaging of brachial plexus trauma in gunshot injury

“…Traumatic injury to the brachial plexus may result in upper extremity motor and sensory impairment, leading to severe disability. Most traumatic brachial plexus injuries in adults are traction injuries, usually caused by vehicular accidents . Injury may also result from penetrating wounds such as stabbing and ballistic trauma; gunshot wounds (GSW) have been reported to cause anywhere between 3% and 12% of brachial plexus injuries .…”

“…Most traumatic brachial plexus injuries in adults are traction injuries, usually caused by vehicular accidents . Injury may also result from penetrating wounds such as stabbing and ballistic trauma; gunshot wounds (GSW) have been reported to cause anywhere between 3% and 12% of brachial plexus injuries . Missiles from a gunshot may cause damage directly by transecting the nerve, or indirectly by producing shock waves that stretch the nerve, resulting in motor and sensory impairment …”