Management of missile injuries of the brachial plexus

Abstract

Missile injuries of the brachial plexus are a challenging group of peripheral nerve injuries. A total of 22 soldiers with penetrating missile injuries were treated at Army Hospital (Research & Referral) from jun 2002 to Apr 2005. 17 patients underwent surgery at a mean of 2 months to 2 years after the injury. The indications were no return of function in the paralysed limb and severe and intractable pain. No operations were performed in 5 patients showing neurological recovery. Neural elements were grafted in 10 patients at three levels: root and trunk level (3); cord level (5) and branch level (2). Microneurolysis was done in 4 patients in whom the proximal root stumps were severely fibrotic and not suitable for grafting. One patient with previous failed repairs was treated by free functioning muschle transfer, two years after the injury. All patients were followed upto 2 years after surgery. Good or useful results (return of power, sensations and relief from neuralgic pain) were obtained in 70% of cases. Poor results were observed after repairs of the medial cord and ulnar nerve. The overall results results achieved after repairs of C5, C6 and C7 roots, and the lateral and posterior cords highly justify a timely surgical intervention in brachial plexus palsy following missile injuries.