Surgical treatment of traumatic lesions of the axillary nerve. A retrospective study of 33 cases.

The purpose of this study was to evaluate the recovery of muscular strength after surgical intervention in axillary nerve injuries. Surgery was elected when no signs of recovery were noted after three months of conservative treatment. Between 1980 and 1996, 46 traumatic lesions of the axillary nerve were surgically treated. Thirteen patients were excluded from the study for various reasons. Among the remaining 33, 20 with interruption of the nerve trunk were treated with nerve grafts and 13 lesions with the nerve in continuity underwent neurolysis. After a mean follow-up of more than two years, deltoid muscle strength was good or fair in 18 patients and poor in 15 cases. The outcome seemed to be better in isolated lesions than in complex nerve lesions with a favourable outcome in 6/10 patients vs 8/14, in patients younger than 25 years compared to older patients (8/14 vs 8/19), in patients treated with neurolysis (9/13) compared to grafting (9/20), and when graft length was limited (4/4 patients with a graft 6cm or less, 5/8 with a graft over 6cm in length). The outcome was less favourable when associated osteoarticular lesions were present (8/23 versus 8/10) and most convincingly, when surgery was delayed beyond six months (10/22 versus 8/11).