Brachial plexus injuries associated with cervical spine fractures.

The concomitant occurrence of brachial plexus injuries and cervical spine fractures in three recent patients is reviewed. The injuries included a fracture or dislocation of the upper portion of the cervical spine and damage to the upper roots of the brachial plexus. All of the patients had associated head injuries and two suffered a spinal cord injury. Recognition of the brachial plexus injury was delayed in each case because of the associated injuries. Probable mechanisms of injury include forced lateral bending of the cervical spine, with or without rotation, combined with forcible depression of the shoulder. All three patients required surgical fusion and/or halo bracing. Two have persistent Erb-type palsies. Brachial plexus injuries must be suspected in all cervical spine injury patients.