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Different methods and results in the treatment of obstetrical brachial plexus palsy
Insights
For obstetrical brachial plexus palsy, surgical intervention is indicated if biceps function doesn't return by 3 months. Nerve transfer and grafting yield better shoulder and elbow function than conservative care or neurolysis.
Area of Science:
- Pediatric Surgery
- Neurology
- Orthopedic Surgery
Background:
- Obstetrical brachial plexus palsy (OBPP) can result in significant upper limb dysfunction.
- Early identification of non-recovery is crucial for timely intervention.
Purpose of the Study:
- To compare functional outcomes of different treatment modalities for OBPP in infants lacking biceps function by 3 months.
- To determine the efficacy of nerve transfer and grafting versus conservative management and neurolysis.
Main Methods:
- Retrospective analysis of 31 patients with OBPP and no biceps recovery by 3 months.
- Mallet's test used to assess shoulder and elbow function.
- Comparison of outcomes between conservative treatment, neurolysis, and nerve transfer/grafting groups.
Main Results:
- Nerve transfer and grafting group showed 70% excellent/good results in shoulder abduction, external rotation, and elbow flexion.
- No good results were observed in the conservative treatment or neurolysis groups.
- Average follow-up was over 44 months for surgical groups.
Conclusions:
- Surgical intervention, specifically nerve transfer and grafting, is recommended for OBPP when biceps function is absent by 3 months.
- Nerve transfer and grafting are superior to conservative treatment and neurolysis for improving shoulder and elbow function in these cases.
Abstract:
Mallet's test was used to evaluate shoulder and elbow functional results following conservative treatment, neurolysis, and nerve transfer and grafting in 31 patients with obstetrical brachial plexus palsy, who had no recovery of biceps contraction by 3 months of age. Twelve of them had been treated conservatively for 3 to 4 years. Nine patients with upper trunk conducting neuromas underwent neurolysis at the age of 4 to 6 months. Nerve transfer and grafting were performed in 10 patients at the age of 3 to 6 months. Upper trunk conducting neuromas were found in six of them. The follow-up period was, on average, 44.3 and 51.5 months in the nerve transfer and grafting group and in the neurolysis group, respectively. Excellent and good results in shoulder abduction, external rotation, and elbow flexion were found in 70 percent of patients in the nerve transfer and grafting group. However, none of the conservative treatment and neurolysis groups had a good result. The authors conclude that when there is no recovery of biceps contraction by 3 months of age, surgical intervention is indicated. Neuroma should be managed by nerve transfer and grafting, even though intraoperative electrophysiologic studies show that the neuroma is a conducting one.