An Experience with Missile Injuries of the Brachial Plexus: Points to Ponder

Abstract

Specific Aims and Objectives: The management of missile injury of the brachial plexus is challenging and functional outcomes differ considerably from highspeed motor vehicle accidents. This study aims to present the functional outcomes following surgical treatment of different grades of missile induced brachial plexus injuries.

Methods: Forty-eight cases of brachial plexus injuries were managed in a tertiary care centre in the period between March 1998 and November 2012. The intraoperative nerve lesions consisted of neuroma- incontinuity, diffuse adhesions, fibrosis, and partial or total disruptions of various elements of the brachial plexus. Nerve grafting, neurolysis and nerve transfer were the most commonly performed procedures. Patients were followed up for a minimum of 3 years after surgery.

Observations: Best functional outcomes were obtained following reconstruction of lateral cord, musculocutaneous and radial nerves. Repairs of upper and middle trunks, posterior cord and median nerve produced satisfactory outcomes. Results were highly unsatisfactory following repair of lower trunk and medial cord lesions.

Conclusion: In the absence of satisfactory neurological recovery, surgical intervention should not be delayed. A timely executed microsurgical reconstruction results in satisfactory to good functional outcomes in missile injuries of the brachial plexus.