734 THE JOURNAL OF BONE AND JOINT SURGERY COMPUTERISED AXIAL TOMOGRAPHY IN TRACTION INJURIES OF THE BRACHIAL PLEXUS

Severe traction injuries may damage the brachial plexus at any level from the spinal cord to the axillary outlet. Investigation aims to determine the level of the injury for each of the nerves, trunks or cords, with particular reference to obtaining firm evidence of any intradural (pre-ganglionic) damage. We report the results of computerised axial tomography of the cervical spine in comparison with conventional myelography and with surgical exploration of the plexus. CT scanning with contrast enhancement greatly improves diagnostic accuracy, particularly at C5 and C6 root levels. Closed traction injury of the brachial plexus is becoming more common because of the increasing number of motorcycle injuries. Seriously injured victims survive more often because the wearing of crash helmets is compulsory (Wynn Parry 1984). In our opinion, an exploratory operation is indicated in the first week after injury when there is clinical evidence ofeither a complete lesion of the brachial plexus or of a reparable lesion. An early operation is relatively easy, it provides an accurat