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Bilateral elbow flexion reconstruction with functioning free muscle transfer for obstetric brachial plexus palsy
A S Baliarsing1, K Doi, Y Hattori
1Department of Orthopaedics, Ogori Daiichi General Hospital, Yamaguchi Prefecture, Japan.
Insights
This study details a surgical solution for persistent elbow flexion issues following obstetric brachial plexus palsy. Free gracilis muscle transfers successfully restored elbow flexion in a child, utilizing the spinal accessory nerve.
Area of Science:
- Pediatric surgery
- Neurology
- Orthopedics
Background:
- Obstetric brachial plexus palsy (OBPP) can result in significant functional deficits, including the loss of elbow flexion.
- Nerve root involvement at C5 and C6 is common in OBPP, impacting shoulder and elbow movement.
- Limited recovery of elbow flexion necessitates reconstructive surgical options.
Observation:
- A child presented with bilateral OBPP affecting C5 and C6 nerve roots.
- Shoulder abduction recovered by age 1, but elbow flexion remained absent bilaterally.
- This functional deficit significantly impacted the child's upper limb use.
Findings:
- Bilateral free gracilis muscle transfers were performed to restore elbow flexion.
- The spinal accessory nerve served as the donor nerve for both muscle transfers.
- The surgical intervention aimed to provide active elbow flexion, improving limb function.
Implications:
- Free muscle transfers are a viable option for reconstructing elbow flexion in cases of OBPP with persistent deficits.
- Utilizing the spinal accessory nerve offers a potential donor source for functional muscle transfers.
- Successful restoration of elbow flexion can significantly enhance a child's quality of life and functional independence.
Abstract:
A child suffered a bilateral obstetric brachial plexus palsy involving the C5 and C6 nerve roots. Abduction of the shoulder joints had recovered by 1 year, but elbow flexion did not recover on either side. Free gracilis muscle transfers were performed on both sides, at an interval of 6 months, to achieve elbow flexion. The spinal accessory nerve was used as the donor nerve.
