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. 2022 Sep;38(7):511-523.
doi: 10.1055/s-0041-1735507. Epub 2021 Sep 1.

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

Heri Suroto  1 , Irene Antoni  2 , Angelina Siyo  2 , Tawatha C Steendam  3 , Tabita Prajasari  1 , Herlambang Budi Mulyono  4 , Brigita De Vega  2   5
Affiliations

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

Heri Suroto et al. J Reconstr Microsurg. 2022 Sep.

Abstract

Background: Brachial plexus injuries (BPI) cause severe physical disability and major psycho-socioeconomic burden. Although various countries have reported BPI incidence, the data from Indonesia as the fourth most populated country in the world remains unknown. We aim to assess the distribution of traumatic BPI, patients' characteristics, and treatment modalities in Indonesia.

Methods: A retrospective investigation was performed comprising 491 BPI patients at a tertiary referral hospital in Indonesia from January 2003 to October 2019. Demographic and outcomes data were retrieved from medical records.

Results: The average BPI patients' age was 27.3 ± 11.6 years old, with a male/female ratio of 4.6:1. Motorcycle accidents caused the majority (76.1%) of all BPI cases. Concomitant injuries were present in 62.3% of patients, dominated by fractures (57.1%) and brain injuries (25.4%). BPI lesion type was classified into complete (C5-T1, observed in 70% patients), upper (C5-C6, in 15% patients), extended upper (C5-C7, in 14% patients), and lower type (C8-T1, in 1% patients). The average time to surgery was 16.8 months (range 1-120 months), with the majority (76.6%) of the patients was operated on six months after the trauma. Free functional muscle transfer (FFMT) was the most common procedure performed (37%). We also analyzed the functional outcomes (active range of motion (AROM) and muscle power), DASH (Disabilities of the Arm, Shoulder, and Hand) score, and VAS (Visual Analogue Scale) across four most frequent procedures involving nerve reconstruction (FFMT, nerve transfer, external neurolysis, and nerve grafting). We found that FFMT was significantly better than nerve transfer in terms of DASH score and VAS (p = 0.000 and p = 0.016, respectively) in complete BPI (C5-T1). Moreover, we also found that nerve grafting resulted in a significantly better shoulder abduction AROM than nerve transfer and external neurolysis in extended upper BPI (C5-C7) (p = 0.033 and p = 0.033, respectively). Interestingly, no significant differences were observed in other measurements.

Conclusion: This study provides an overview of traumatic BPI patients in a single tertiary trauma center in Indonesia, expressing the profile of their characteristics and functional outcomes after surgical procedures.

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Conflict of interest statement

The authors declare that they have no conflict of interest.Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article

Figures

Fig. 1
Fig. 1
Total BPI patients in the study period.
Fig. 2
Fig. 2
The distribution of BPI patients in Indonesia.
Fig. 3
Fig. 3
Age distribution.
Fig. 4
Fig. 4
Time to surgery.
Fig. 5
Fig. 5
The distribution of paralysis.
See this image and copyright information in PMC

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