Traumatic brachial plexus injury: literature review and clinical case

Abstract

Of all injuries to the nervous system, the percentage of peripheral nervous system injuries is 1-6%. Of this number, injuries to the brachial plexus and its branches account for between 60 and 81 %. This topic is relevant because inadequate treatment of traumatic injuries of the brachial plexus leads to permanent disability. The paper presents a clinical classification of traumatic injuries: according to the mechanism of damage: closed (traction and as a result of a blow to the clavicle area with compression of the brachial plexus), open (stab-cut, gunshot); on the topographical level: postganglionic, intraspinal, trauma of secondary trunks. The level and nature of damage to the brachial plexus is determined by radiography, its functional state is determined by ENMG, ultrasound indicates a hematoma, MRI allows you to determine root avulsion, scar changes, CT myelography - preganglionic damage, and thermal imaging-lesion of plexus brachialis branches.Neurosurgeons, traumatologists, reconstructive and plastic surgeons are engaged in surgical treatment of mold plexus injuries. Currently, 4 accesses are used: supraclavicular posterolateral (intervention on the upper and middle trunk, saves blood vessels), subclavian (operations on secondary bundles, short branches, also used if necessary for neurotic intercostal nerves), transaxillary (visualizes the lower trunk), posterior supraclavicular (wide access for all trunks, but causes instability of the cervical spine). A clinical case of traumatic right brachioplexopathy resulting from a motorcycle accident reflects the complexity of patient routing, differential diagnosis between vascular and neurosurgical pathology, and long-term rehabilitation. This case demonstrates the complexity of diagnosis and rehabilitation of patients with this pathology. It is concluded that the most effective operation for severing spinal roots is neurotization.