A systematic review of outcomes following transhumeral amputation for brachial plexus injury.

Abstract

Brachial plexus injuries (BPI) are devastating conditions that frequently result in flail, insensate upper limbs associated with severe neuropathic pain and loss of function. When reconstructive options such as nerve grafts, transfers, or free muscle transplantation fail to restore meaningful function, transhumeral amputation may be considered as a salvage strategy. The advent of advanced prosthetic technologies, particularly myoelectric and osseointegrated devices, has renewed interest in elective amputation for select patients. This systematic review evaluates functional, pain, prosthetic, and quality-of-life outcomes following transhumeral amputation for traumatic BPI. A systematic search of PubMed, Embase, and Scopus (May 2025) was conducted according to PRISMA guidelines. Eligible studies reported outcomes of transhumeral amputation following traumatic BPI. Non-English, non-original, and non-BPI amputation studies were excluded. Data extraction and quality assessment were performed independently by two reviewers using the MINORS tool. Continuous data (e.g. DASH, VAS) were pooled using a random-effects meta-analysis (RevMan 5.4). Heterogeneity was assessed using the I² statistic, and subgroup analyses explored differences by prosthesis type (myoelectric vs. cosmetic/traditional). Ten studies encompassing 93 patients met inclusion criteria (Level III-IV evidence, follow-up 3-19 years). Mean postoperative DASH score was 35.0 (95 % CI 28.0-42.0), indicating moderate residual disability but a significant functional improvement from preoperative values (ΔDASH = -13.5; 95 % CI -21.9 to -5.1). Myoelectric users demonstrated superior functional outcomes (mean DASH 30.7) compared with cosmetic or traditional users (means 37-43; p = 0.008). Pooled VAS pain score was 5.6 (95 % CI 3.1-8.1) with a nonsignificant trend towards improvement (ΔVAS -1.2). Regular prosthesis use occurred in 51 % (95 % CI 27-74 %), and approximately 37 % of patients returned to work. Patient satisfaction exceeded 80 % in most series, particularly among myoelectric prosthesis users. Transhumeral amputation following brachial plexus injury yields clinically meaningful functional gains and high patient satisfaction, especially when combined with modern prosthetic technology. Pain reduction is variable, and return-to-work rates remain modest. Amputation should be considered a valid reconstructive endpoint in selected patients when conventional nerve reconstruction fails. Future multicentre prospective studies employing standardised outcome measures are essential to refine patient selection, quantify long-term benefit, and optimise multidisciplinary rehabilitation strategies.