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Function of the upper limb after surgery for obstetric brachial plexus palsy
C E Dumont1, V Forin, H Asfazadourian
1Hĵpital d'Enfants Armand Trousseau, Paris, France.
The Journal of Bone and Joint Surgery. British Volume
|August 28, 2001
Summary
Surgery for obstetric brachial plexus palsy in infants can restore function. Nerve reconstruction and transfers improved shoulder and elbow function, with hand grasp recovery linked to pre-operative movement.
Area of Science:
- Pediatric Surgery
- Neurology
- Orthopedics
Background:
- Obstetric brachial plexus palsy (OBPP) is a birth injury affecting infant arm function.
- Surgical intervention is considered for OBPP when conservative management fails.
Purpose of the Study:
- To evaluate the surgical outcomes of nerve reconstruction and muscle/tendon transfers in infants with OBPP.
- To identify factors influencing functional recovery after surgery for OBPP.
Main Methods:
- Retrospective review of 33 infants undergoing surgery for OBPP at a mean age of 4.7 months.
- Surgical procedures included nerve reconstruction, muscle transfer (shoulder/elbow), and tendon transfer (hand).
- Mean follow-up was 4 years 8 months.
Main Results:
- Children with upper palsy showed significant recovery: 70% useful shoulder function, 75% useful elbow function.
- Children with total palsy had lower recovery rates: 20% useful shoulder, 35% useful elbow function.
- Satisfactory hand sensation was common in total palsy cases; grasp recovery depended on pre-operative hand movement.
Conclusions:
- Surgical interventions for OBPP can lead to useful shoulder and elbow function, particularly in upper palsy cases.
- Hand grasp recovery is achievable but relies on pre-existing hand movement.
- Coordinated arm and hand movement post-surgery is associated with hand sensation and prehension.