[Early microsurgical management of clavicular fracture combined with brachial plexus injury].

OBJECTIVE: To investigate the management strategies of clavicular fracture combined with brachial plexus injury and its effectiveness.

METHODS: Between January 2006 and January 2012, 27 cases of clavicular fracture combined with brachial plexus injury were treated. There were 18 males and 9 females, aged 18-42 years (mean, 25.3 years). The causes of injury were traffic accident in 12 cases, falling from height in 10 cases, bruise in 3 cases, machinery injury in 2 cases. According to the Robinson classification, the clavicular fractures were rated as type I in 2 cases, as type II in 20 cases, and as type III in 5 cases; there were 12 cases of total brachial plexus root avulsion injury, 10 cases of bundle branch injury, and 5 cases of hematoma formation and local nerve compression or injury. The injury to operation time was 6 hours to 14 days (mean, 4 days). Brachial plexus injury was repaired by epineurium neurolysis, nerve anastomosis, or nerve transposition after the exploration of the plexus; and fracture was fixed after open reduction. Sensory grading standard (S0-S4) by UK Medical Research Council (MRC) was used to evaluate the recovery of sensory function, and muscle strength grading standard (M0-M5) by MRC to evaluate the innervating muscle strength.

RESULTS: The incisions healed by first intention. All patients were followed up 18-36 months (mean, 26.3 months). All fracture achieved clinical healing at 12-17 weeks (mean, 15 weeks). No complication of loosening or breakage of internal fixation occurred. The patients had no pain of shoulder in abduction. At 18 months after operation, the shoulder abduction was more than or equal to 60° in 8 cases, 30-60° in 8 cases, and less than 30° in 11 cases. The recovery of biceps muscle strength was more than or equal to M3 in 18 cases and less than M3 in 9 cases; the recovery of wrist flexion or flexor muscle strength was more than or equal to M3 in 13 cases and less than M3 in 14 cases. The sensory function recovery of median nerve was S3 in 14 cases, S1-S2 in 9 cases, and So in 4 cases. The shoulder abduction, elbow and wrist flexor motor function did not recover in 2 patients with total brachial plexus root avulsion injury.

CONCLUSION: It is beneficial to the recovery of nerve function to early repair of the brachial plexus injury by exploration of the plexus combined with open reduction and fixation of clavicular fractures, the short-term effectiveness is good.