[Obstetric brachial plexus palsy--clinics, pathophysiology and surgical treatment]

Obstetric brachial plexus palsy is a rare but sometimes severe traction injury. Peripheral nerve microsurgery (neurolysis, interfascicular grafting) and secondary procedures including muscle and tendon transfers altogether with contracture releases have improved the prognosis over the last 20 years. This article includes a historical review, the ongoing discussion about the pathophysiology (frequent traction injury vs. rare intrauterine maladaptation) and the clinics. Based on a patient group of 500 children with 100 microsurgical plexus reconstructions, we describe the surgical technique and our experience with primary nerve reconstruction. A concept about secondary procedures according to the joint levels is shortly exposed together with various modalities of postoperative evaluation, including video-assisted movement analysis. We conclude that severe upper and complete plexus palsies without significant recovery should be explored and reconstructed by microsurgical techniques.