الفهرس 
HISTORICAL REVIEWOnly 14 pages are availabe for public view
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Abstract
from 2010 to 2013, 20 patients with traumatic brachial plexus palsy, with exclusion of birth injuries, were operated for brachial plexus exploration and reconstruction.
Available patients were followed up for more than 24 months. Out of which 14 (70%) were males and 6(30%) were females.The age at surgery ranged between 5-40 years .The right side was affected in 12 (60 %) patients and left side in 8 patients (40 %).Motor cycle accidents and road traffic accidents was the most common cause of the injury (60%).Horner’s syndrome was noted in 3 cases (15%) and winging of scapula in 4 cases (20%).
EMG and NCV were used in all cases at least after 3 week from the trauma to assess the nerve conduction and the level of injury of the affected part. SEP with SCS is important to distinguish preganglionic from postganglionic injury.
Roentgenograms of chest, clavicle, shoulder, and elbow were obtained to diagnose associated fractures and elevated copula of diaphragm, indicating phrenic nerve injury.
CT myelography was done for 2 cases , MRI cervical spine was done in 6 cases (30%). Images were examined for the presence of vertebral fracture, spinal canal alignment, intraspinal canal hematoma, meningocele and nerve root visualization.
None of examined cases revealed vertebral fracture, MRI did not signify a specific or a peculiar type of lesion; it might specify root avulsion.
Surgery should be performed in the absence of clinical or electrical evidence of recovery or when spontaneous recovery is impossible. Only one case operated immediately as it was due to iatrogenic cause.
Surgical procedures included neurolysis;neuroma excision and interposition nerve grafting; and neurotization, using spinal accessory nerve, Oberlin transfer ,intercostal nerves and nerve to long head of triceps. Nerve suture was done in all cases using 10/0 Nylon suture.