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[Treatment of early and late obstetric brachial plexus palsy]
Ramune Degliūte1, Sigitas Pranckevicius, Emilis Cekanauskas
1Clinic of Pediatric Surgery, Kaunas University of Medicine Hospital, Eiveniu 2, 50010 Kaunas, Lithuania. rdegliute@hotmail.com
Insights
Most newborns with obstetric brachial plexus palsy recover with conservative treatment. Secondary reconstructive surgery can improve outcomes for older children with deformities.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Obstetric brachial plexus palsy (OBPP) is a birth injury affecting newborns.
- Treatment strategies vary for early and late OBPP, impacting long-term outcomes.
Purpose of the Study:
- To review and analyze treatment patterns for early and late OBPP.
- To evaluate the effectiveness of conservative and operative interventions.
Main Methods:
- Retrospective analysis of 81 children treated between 1988-2002.
- Classification into conservative (67 newborns) and operative (14 children) groups.
- Evaluation of active hand movements and innervation pre- and post-treatment.
Main Results:
- Thirty newborns achieved full recovery; 32 had incomplete recovery; 5 showed no improvement with conservative care.
- Operative treatment for late OBPP included osteotomies and tendon transfers, leading to improved active hand movements.
- Specific surgeries: rotation osteotomy (10), tendon lengthening (6), tendon transpositions (5).
Conclusions:
- Conservative management is often successful for early OBPP.
- Secondary reconstructive surgery can significantly improve functional outcomes in late OBPP with deformities.
- Early diagnosis and appropriate intervention are crucial for managing OBPP.
Abstract:
The aim of this study was to review and to analyze treatment patterns of early and late obstetric brachial plexus palsy. Eighty-one children with early and late obstetric brachial plexus palsy were treated in the Department of Pediatric Orthopedics and in the Postintensive Care Unit within the period 1988-2002. Children were classified into 2 groups according to age: Ist group (67 newborns) was treated conservatively, and IInd group (14 children with late obstetric brachial plexus palsy with deformity) underwent operative treatment. Active hand movements and innervation were evaluated before and after treatment. Thirty newborns had full recovery, 32 newborns had incomplete recovery, and in 5 cases no improvement was seen. Fourteen children with late obstetric brachial plexus palsy underwent the following operations: rotation osteotomy of the humerus was performed in 10 cases, lengthening of biceps and brachialis muscle tendons--in 6 cases, transposition of triceps muscle tendon--in 1 case, transposition of pectoralis major tendon--in 3 cases and flexor carpi transposition--in 1 case. There was an improvement in active hand movements after operative treatment and rehabilitation. According to our experience, in most cases newborns recover spontaneously or after conservative treatment. Secondary reconstructive surgery of late brachial plexus palsy can improve the condition of these patients.
