Leffert Classification

Brachial plexus injuries are classified according to the aetiology and level of the lesion. The Leffert classification (Table 1) considers brachial plexus lesions in four types. Iatrogenic and tumour-related lesions can be added to this classification. Closed traction injuries account for >75% of lesions. Lesions may be at more than one level.

Table 1. Leffert classification of brachial plexus injuries

I Open

II Closed IIA Supraclavicular

Preganglionic - nerve root avulsion Postganglionic - traction injuries IIB Infraclavicular

III Radiotherapy induced

IV Obstetric IVA Upper root (Erb's palsy)

IVB Lower root (Klumpke's palsy)

IVC Mixed

The Sunderland classification is also popular, with five degrees of brachial plexus injury of increasing severity - neurapraxia is 1st degree, axonotmesis 2nd degree, lesions of increasing severity but in continuity 3rd and 4th degree, and complete transection is 5th degree.

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