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Age and Injury Severity Score Impact Restoration of Shoulder Abduction and External Rotation following Root Grafting for Pan-Brachial Plexus Injury
Neill Y Li, MD1; Kitty Wu, MD, FRCSC2; Michelle Kircher, PNR2; Allen T Bishop, MD3; Robert J. Spinner, MD4; Shin Alexander, MD5
1Mayo Clinic, Rochester, RI; 2Mayo Clinic, Rochester, MN; 3Microvascular Research Laboratory, Mayo Clinic, Rochester, MN; 4Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN; 5Orthopedic Surgery, Mayo Clinic, Rochester, MN

INTRODUCTION: Outcomes of shoulder function following root grafting in pan-brachial plexus injuries have not been well addressed. This study aimed to determine return of shoulder abduction(ABD) with or without external rotation(ER) following root grafting for pan-brachial plexus injuries. Secondarily aimed to assess patient, injury, and surgical factors that influence outcomes.
METHODS: 362 patients with pan-brachial plexus reconstructions at a single institution between 2001 and 2018 were reviewed for those that underwent root grafting for shoulder function. Patients without reconstruction to suprascapular nerve(SSN) and axillary nerve(AxN) or posterior division of the upper trunk(PDUT) and less than 18 months of follow-up were excluded. Demographics, injury severity score(ISS), graft factors, BRMC and active range of motion(AROM) for shoulder ABD and ER, DASH, and pain VAS were recorded. Continuous variables were assessed with one-way ANOVA and Tukey’s multiple comparison tests and categorical variables with Fisher’s Exact test. Multivariable logistic regression was performed for significant factors.
RESULTS: 110 patients underwent root grafting with 41(37.3%) meeting inclusion criteria. The mean age was 29.0(±12.3), BMI was 26.1(±4.7), ISS was 15.4(±9.5) and follow-up was 38.0(±34.5) months(Table 1). 17(41.5%) had no return of shoulder function, 14(34.1%) had ABD alone, and 10(24.4%) had ABD and ER(Table 2). Patients with ABD demonstrated a BMRC of 2(±0.5), AROM of 38.1°(±21.9°) and those with ER had a BMRC of 2(±0), AROM of 24.4°(±11.6°). Patients with ABD and ER were either significantly younger(18.6 ± 5.56), had lower BMI(22.4 ± 4.0), or lower ISS(10.5 ± 6.24, P=0.003)(Table 2). The mean number of cables to SSN in patients with ABD and ER was significantly greater(2.13 ± 1.36) (Table 2). Multivariable analysis found that with increasing age (OR:0.786, 95%CI:0.576,0.941) and ISS (OR:0.820, 95%CI:0.606,0.979), the odds for return of ABD and ER significantly decreased.
CONCLUSION: About 25% of patients demonstrated return of both ABD and ER following root grafting for pan-brachial plexus injuries. Increasing age and ISS independently increased risk for poor shoulder function. Taken together, the intrinsic ability of nerves to regenerate as related to age and magnitude of injury to the plexus with associated polytrauma significantly impact outcomes of root grafting for shoulder function.


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