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CC BY-NC-ND 4.0 · J Reconstr Microsurg 2022; 38(07): 511-523
DOI: 10.1055/s-0041-1735507
Original Article

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

Heri Suroto 
1   Department of Orthopaedic and Traumatology, Dr Soetomo General Academic Hospital/ Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
,
Irene Antoni
2   Research Fellow at Cell and Tissue Bank Regenerative Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
,
Angelina Siyo
2   Research Fellow at Cell and Tissue Bank Regenerative Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
,
Tawatha C. Steendam
3   Leiden University Medical Centre, The Netherlands
,
Tabita Prajasari
1   Department of Orthopaedic and Traumatology, Dr Soetomo General Academic Hospital/ Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
,
Herlambang Budi Mulyono
4   Faculty of Medicine Universitas Cendrawasih, Jayapura/ Papua, Indonesia
,
Brigita De Vega 
2   Research Fellow at Cell and Tissue Bank Regenerative Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
5   Institute of Orthopaedics and Musculoskeletal Science, University College London, United Kingdom
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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.

Keywords

traumatic brachial plexus injury - brachial plexus neuropathies - epidemiologic studies - developing countries - nerve reconstruction - reconstructive surgery

Ethical Approval

Approval for this study was obtained from our institution's ethical clearance (Reference number: 1399/KEPK/VIII/2019).


Author Contribution

HS devised the project, the main conceptual ideas and proof outline. IA, AS, TCS, TP, BDV, and HM processed the experimental data, performed the analysis, and drafted the manuscript. All authors discussed the results and reviewed the manuscript.


Data Availability

The authors confirm that the data supporting the findings of this study are available within the article.




Publication History

Article published online:
01 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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