Other mechanisms

Though less common than closed injuries, open injuries do occur. If the mechanism results in sharp division (eg, by means of a knife), direct repair may be possible. Iatrogenic injuries have been reported from multiple surgical procedures, including mastectomy, first rib resection, and subclavian carotid bypass [19-21]. Emergency exploration for open trauma is usually only warranted in cases of vascular injury or sharp laceration. Lower truck injuries are more likely to have concomitant vascular injuries. Open injuries caused by gunshot wounds are best managed conservatively because the nerve in these injuries is rarely transected [9].

Brachial Plexus Mechanism

Fig. 6. Upper brachial plexus injuries occur when the head and neck are violently moved away from the ipsilateral shoulder. The shoulder is forced downward whereas the head is forced to the opposite side. The result is a stretch, avulsion, or rupture of the upper roots (C5, C6, C7), with preservation of the lower roots (C8, T1). (Courtesy of the Mayo Foundation, Rochester, MN; with permission.)

Fig. 6. Upper brachial plexus injuries occur when the head and neck are violently moved away from the ipsilateral shoulder. The shoulder is forced downward whereas the head is forced to the opposite side. The result is a stretch, avulsion, or rupture of the upper roots (C5, C6, C7), with preservation of the lower roots (C8, T1). (Courtesy of the Mayo Foundation, Rochester, MN; with permission.)

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