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

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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.

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References

  1. Ahmed-Labib M, Golan JD, Jacques L (2007) Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery 61:1016–1022; discussion 1022-1013. https://doi.org/10.1227/01.neu.0000303197.87672.31

    Article  PubMed  Google Scholar 

  2. Akita S, Wada E, Kawai H (2006) Combined injuries of the brachial plexus and spinal cord. J Bone Joint Surg Br Vol 88:637–641. https://doi.org/10.1302/0301-620X.88B5.17175

    Article  CAS  Google Scholar 

  3. Altaf F, Mannan K, Bharania P, Sewell MD, Di Mascio L, Sinisi M (2012) Severe brachial plexus injuries in rugby. Injury 43:272–273. https://doi.org/10.1016/j.injury.2011.04.001

    Article  CAS  PubMed  Google Scholar 

  4. Bertelli JA, Ghizoni MF, Soldado F (2017) Patterns of brachial plexus stretch palsy in a prospective series of 565 surgically treated patients. J Hand Surg 42:443–446.e2. https://doi.org/10.1016/j.jhsa.2017.03.021

    Article  Google Scholar 

  5. Brown AF (1995) Chainsaw penetrating neck injury. J Accid Emerg Med 12:134–137

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Coene LN (1993) Mechanisms of brachial plexus lesions. Clin Neurol Neurosurg 95(Suppl):S24–S29

    Article  PubMed  Google Scholar 

  7. de Moraes FB, Kwae MY, da Silva RP, Porto CC, Magalhaes Dde P, Paulino MV (2015) Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment. Rev Bras Ortop 50:556–561. https://doi.org/10.1016/j.rboe.2015.08.015

    Article  PubMed  PubMed Central  Google Scholar 

  8. Demuynck M, Zuker RM (1995) Biceps tendon rupture after successful reinnervation: a case report. Acta Orthop Belg 61:55–58

    CAS  PubMed  Google Scholar 

  9. Eser F, Aktekin LA, Bodur H, Atan C (2009) Etiological factors of traumatic peripheral nerve injuries. Neurol India 57:434–437. https://doi.org/10.4103/0028-3886.55614

    Article  PubMed  Google Scholar 

  10. Flores LP (2006) Epidemiological study of the traumatic brachial plexus injuries in adults. Arq Neuropsiquiatr 64:88–94

    Article  PubMed  Google Scholar 

  11. Goldie BS, Coates CJ (1992) Brachial plexus injury: a survey of incidence and referral pattern. J Hand Surg 17:86–88

    Article  CAS  Google Scholar 

  12. Gousheh J (2001) War injuries. In: Gilbert A (ed) Brachial plexus injuries. Martin Dunitz, London, pp 321–325

    Google Scholar 

  13. Jain DK, Bhardwaj P, Venkataramani H, Sabapathy SR (2012) An epidemiological study of traumatic brachial plexus injury patients treated at an Indian Centre. Indian J Plast Surg 45:498–503. https://doi.org/10.4103/0970-0358.105960

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jiang S, Li ZY, Hua XY, Xu WD, Xu JG, Gu YD (2010) Reorganization in motor cortex after brachial plexus avulsion injury and repair with the contralateral C7 root transfer in rats. Microsurgery 30:314–320. https://doi.org/10.1002/micr.20747

    Article  PubMed  Google Scholar 

  15. Johnson EO, Vekris MD, Zoubos AB, Soucacos PN (2006) Neuroanatomy of the brachial plexus: the missing link in the continuity between the central and peripheral nervous systems. Microsurgery 26:218–229. https://doi.org/10.1002/micr.20233

    Article  PubMed  Google Scholar 

  16. Johnston GM, Urquhart R, Lethbridge L, MacIntyre M (2016) Increasing our understanding of dying of breast cancer: comorbidities and care. Prog Palliat Care 24:147–152. https://doi.org/10.1080/09699260.2015.1108638

    Article  CAS  PubMed  Google Scholar 

  17. Kaiser R, Haninec P (2012) The influence of seatbelts on the types of operated brachial plexus lesions caused by car accidents. J Hand Surg 37:1657–1659. https://doi.org/10.1016/j.jhsa.2012.05.019

    Article  Google Scholar 

  18. Kaiser R, Ullas G (2016) Acutely reconstructed isolated supraclavicular brachial plexus injury caused by a chainsaw. Plast Surg Case Stud 2:7–8

    Article  Google Scholar 

  19. Kaiser R, Waldauf P, Haninec P (2012) Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents. Acta Neurochir 154:1293–1297. https://doi.org/10.1007/s00701-012-1291-7

    Article  PubMed  Google Scholar 

  20. Kaiser R, Mencl L, Haninec P (2014) Injuries associated with serious brachial plexus involvement in polytrauma among patients requiring surgical repair. Injury 45:223–226. https://doi.org/10.1016/j.injury.2012.05.013

    Article  PubMed  Google Scholar 

  21. Kawai H, Kawabata H (2000) Brachial plexus palsy. World Scientific Publishing, Singapore

    Book  Google Scholar 

  22. Kim DH, Kline DG (2008) Kline & Hudson’s nerve injuries: operative results for major nerve injuries, entrapments and tumors. Saunders Elsevier, Philadelphia

    Google Scholar 

  23. Kim DH, Cho YJ, Tiel RL, Kline DG (2003) Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University health sciences center. J Neurosurg 98:1005–1016. https://doi.org/10.3171/jns.2003.98.5.1005

    Article  PubMed  Google Scholar 

  24. Kim DH, Murovic JA, Tiel RL, Kline DG (2005) Lacerations to the brachial plexus: surgical techniques and outcomes. J Reconstr Microsurg 21:435–440. https://doi.org/10.1055/s-2005-918895

    Article  PubMed  Google Scholar 

  25. Kim DH, Murovic JA, Tiel RL, Kline DG (2006) Gunshot wounds involving the brachial plexus: surgical techniques and outcomes. J Reconstr Microsurg 22:67–72. https://doi.org/10.1055/s-2006-932499

    Article  PubMed  Google Scholar 

  26. Krishnan KG, Martin KD, Schackert G (2008) Traumatic lesions of the brachial plexus: an analysis of outcomes in primary brachial plexus reconstruction and secondary functional arm reanimation. Neurosurgery 62:873–885; discussion 885-876. https://doi.org/10.1227/01.neu.0000318173.28461.32

    Article  PubMed  Google Scholar 

  27. Lanaras TI, Schaller HE, Sinis N (2009) Brachial plexus lesions: 10 years of experience in a center for microsurgery in Germany. Microsurgery 29:87–94. https://doi.org/10.1002/micr.20583

    Article  PubMed  Google Scholar 

  28. Midha R (1997) Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery 40:1182–1188 discussion 1188-1189

    Article  CAS  PubMed  Google Scholar 

  29. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  30. Narakas AO (1985) The treatment of brachial plexus injuries. Int Orthop 9:29–36

    Article  CAS  PubMed  Google Scholar 

  31. Nyaga VN, Arbyn M, Aerts M (2014) Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 72:39. https://doi.org/10.1186/2049-3258-72-39

    Article  PubMed  PubMed Central  Google Scholar 

  32. Rhee PC, Pirola E, Hebert-Blouin MN, Kircher MF, Spinner RJ, Bishop AT, Shin AY (2011) Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. J Bone Joint Surg Am 93:2271–2277. https://doi.org/10.2106/JBJS.J.00922

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rosson JW (1987) Disability following closed traction lesions of the brachial plexus sustained in motor cycle accidents. J Hand Surg 12:353–355

    Article  CAS  Google Scholar 

  34. Samadian M, Rezaee O, Haddadian K, Sharifi G, Abtahi H, Hamidian M, Khormaee F, Sodagari F (2009) Gunshot injuries to the brachial plexus during wartime. Br J Neurosurg 23:165–169. https://doi.org/10.1080/02688690902756686

    Article  PubMed  Google Scholar 

  35. Samardzic MM, Rasulic LG, Grujicic DM (1997) Gunshot injuries to the brachial plexus. J Trauma 43:645–649

    Article  CAS  PubMed  Google Scholar 

  36. Scott BA, Fletcher JR, Pulliam MW, Harris RD (1986) The Beirut terrorist bombing. Neurosurgery 18:107–110

    Article  CAS  PubMed  Google Scholar 

  37. Secer HI, Daneyemez M, Tehli O, Gonul E, Izci Y (2008) The clinical, electrophysiologic, and surgical characteristics of peripheral nerve injuries caused by gunshot wounds in adults: a 40-year experience. Surg Neurol 69:143–152; discussion 152. https://doi.org/10.1016/j.surneu.2007.01.032

    Article  PubMed  Google Scholar 

  38. Secer HI, Solmaz I, Anik I, Izci Y, Duz B, Daneyemez MK, Gonul E (2009) Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults. J Brachial Plexus Peripher Nerve Inj 4(11):e66–e75. https://doi.org/10.1186/1749-7221-4-11

    Article  Google Scholar 

  39. Songcharoen P (1995) Brachial plexus injury in Thailand: a report of 520 cases. Microsurgery 16:35–39

    Article  CAS  PubMed  Google Scholar 

  40. Songcharoen P (2001) Etiology. In: Gilbert A (ed) Brachial plexus injuries. Martin Dunitz, London, pp 47–50

    Google Scholar 

  41. Stewart RL, Black GB (2004) Snowmobile trauma: 10 years’ experience at Manitoba’s tertiary trauma Centre. Can J Surg 47:90–94

    PubMed  PubMed Central  Google Scholar 

  42. Sunderland S (1974) Mechanisms of cervical nerve root avulsion in injuries of the neck and shoulder. J Neurosurg 41:705–714. https://doi.org/10.3171/jns.1974.41.6.0705

    Article  CAS  PubMed  Google Scholar 

  43. Terzis JK, Vekris MD, Soucacos PN (1999) Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plast Reconstr Surg 104:1221–1240

    Article  CAS  PubMed  Google Scholar 

  44. Vekris MD, Beris AE, Johnson EO, Korobilias AV, Pafilas D, Vekris AD, Soucacos PN (2006) Musculocutaneous neurotization to restore elbow flexion in brachial plexus paralysis. Microsurgery 26:325–329. https://doi.org/10.1002/micr.20246

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank all the authors of the eligible articles included in this meta-analysis.

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Authors and Affiliations

  1. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic

    Radek Kaiser

  2. Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University and Hospital Královské Vinohrady, Prague, Czech Republic

    Petr Waldauf

  3. Department of ENT, Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, Carlisle, UK

    Gautham Ullas

  4. Department of Plastic Surgery, First Faculty of Medicine, Charles University and Hospital Na Bulovce, Prague, Czech Republic

    Aneta Krajcová

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  1. Radek Kaiser
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Correspondence to Radek Kaiser.

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Not needed. Ethical approval was not required since this meta-analysis utilized published data which were already ethically approved (see Methods section).

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The authors declare that they have no conflict of interest.

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Kaiser, R., Waldauf, P., Ullas, G. et al. Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: systematic review and meta-analysis. Neurosurg Rev 43, 443–452 (2020). https://doi.org/10.1007/s10143-018-1009-2

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  • DOI: https://doi.org/10.1007/s10143-018-1009-2

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