Traumatic Braquial Plexus Injuries

Clinical evaluation in brachial plexus injury is the most essential step for preoperative and postoperative judgments. The definite diagnosis of the brachial plexus injury is based on the detailed physical and neurological examination, NCV/EMG, and image study, confirmed by the intraoperative findings. The majority of BPIs result from closed traction trauma. The degree and extent of injury are difficult to be judged at acute stage and the delay exploration at 4–6 months after the primary injury is recommended. In this chapter, the operative choices are implemented according to Chuang’s four levels of brachial plexus injury classification. Nerve reconstruction is the first priority for most cases in the acute stage. Proximal nerve graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder and elbow function simultaneously. Distal nerve or close target nerve transfer can offer more efficient and effective functional outcome, and therefore, is more and more popular in recent years. Combined, both strategies in primary nerve reconstruction are especially recommended when there is no healthy or not enough donor nerve available. The palliative surgeries such as FFMT, local muscle or tendon transfer, and arthrodesis are only done when the nerve reconstruction failed or for overall outcome augmentation. Postoperative care of splinting and rehabilitation including physiotherapy (to avoid joint stiffness), muscle stimulation (to delay muscle atrophy), brain cognition, biofeedback, and occupational therapy are indispensable. The final goal is to restore the functional limb and the patient can return back to the school or society successfully.