Brachial Plexus Injury Patterns and Root Graftability: Implications for Reconstruction in 105 Patients

Purpose Traumatic brachial plexus injuries exhibit diverse patterns with variable reconstructive possibilities. Because the availability of graftable spinal nerves is largely determined by the extent of root injury, understanding the relationship between injury patterns and root graftability may facilitate surgical planning. This study aimed to characterize brachial plexus injury patterns and evaluate their relationship with root graftability.Methods A retrospective review was performed on 105 consecutive brachial plexus injury patients who underwent surgical reconstruction between 2021 and 2024 at a tertiary referral center. Preoperative clinical examination and magnetic resonance neurography were correlated with intraoperative findings to determine injury patterns and root graftability.Results Among the 105 patients, 40% presented with panplexus injuries, 42% with upper plexus injuries, and 14% with infraclavicular injuries. The most frequent injury pattern was complete root avulsion from C5-T1 (21%), followed by panplexus with at least one graft-eligible root (19%). The proportion of grafted spinal nerves was 35.8% for C5, 11.5% for C6, and 5.7% for C7. Magnetic resonance neurography (MRN) demonstrated similar rates of potentially graftable C5 in panplexus and upper type injuries (49% vs 36%). Intraoperative exploration confirmed graftability in 28 of 29 C5 roots predicted to be graft-eligible by MRN.Conclusions Brachial plexus injury patterns influence root graftability and reconstructive planning. Despite greater severity, panplexus injuries demonstrated comparable rates of graft-eligible C5 roots to upper plexus injuries. These findings support routine exploration and highlight the value of MRN in identifying graftable spinal nerves.Type of study/level of evidence Diagnostic IV.