Download PDF
Indian Journal of Neurotrauma 2006; 03(01): 49-54
DOI: 10.1016/S0973-0508(06)80010-9
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Management of Missile Injuries of the Brachial Plexus

PS Bhandari
,
LP Sadhotra
,
P Bhargava
,
AS Bath
,
MK Mukherjee
,
P Singh
*   Department of Neurosurgery Army Hospital (R&R), Delhi Cantt-110010
,
V Langer Col
› Author Affiliations
Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

  PDF Download  Permissions and Reprints

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.

Keywords

missile injuries - brachial plexus
 

  • References

  • 1 Bhandari PS, Sadhotra LP, Bhargava P, Bath AS, Singh P, Mukherjee MK. Microsurgical reconstruction for devastating brachial plexus injuries. Ind J Neurotrauma 02 2005; 35-39
    PubMedGoogle Scholar
  • 2 Gousheh J. The treatment of war injuries in the brachial plexus. J Hand Surg (Ann) 20-A 1995; 576-586
    PubMedGoogle Scholar
  • 3 Brook DM. Peripheral nerve injuries. Medical Research Council Special Report Series HMSO 1954; 418-429
    PubMedGoogle Scholar
  • 4 Nelson KG, Jolly PC, Thomas PA. Brachial plexus injuries associated with missile wounds of the chest: a report of 9 cases from Vietnam. J Trauma 08 1968; 268-275
    CrossrefPubMedGoogle Scholar
  • 5 Goerke hc Heinz. Ambrose Pare: Pioneer of modern surgery. Medical Corps International 08 1988; 14-18
    PubMedGoogle Scholar
  • 6 Berlin RH, Janzen B, Liden E. et al Wound ballistics of Swedish 5.56mm assault rifle AK 56. J Trauma 28 suppl 1988; 76-83
    PubMedGoogle Scholar
  • 7 Harvey EN, Mc Millen JH. An experimental study of shock waves resulting from the impact of high velocity missiles on animal tissues. J Exp Med 85 1947; 321-328
    CrossrefPubMedGoogle Scholar
  • 8 Woodruff CE. The causes of explosive effect of modern small caliber bullets. NY Med J 67 1898; 593-601
    PubMedGoogle Scholar
  • 9 Swan KG, Swan RC. Principles of ballistic applicable to the treatment of gunshot wounds. Surg Clin N Am 41 1991; 221-238
    PubMedGoogle Scholar
  • 10 Fackler ML, Surnchak JS, Malinowski JA. et al Bullet fragmentation: A major cause of tissue disruption. J Trauma 24 1984; 35-39
    CrossrefPubMedGoogle Scholar
  • 11 Narakas AO. The treatment of brachial brachial plexus injuries. Int Orthop 09 1985; 29-36
    CrossrefPubMedGoogle Scholar
  • 12 Nathan PW. Pain and the sympathetic system. J Auton Nerv Syst 07 1983; 363-370
    CrossrefPubMedGoogle Scholar
  • 13 Friedman AH, Nashold Jr BS, Bronec PR. Dorsal root entry zone lesions for the treatment of brachial plexus avulsion injury: a follow up study. Neurosurgery 22 1988; 369-373
    CrossrefPubMedGoogle Scholar