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Updated: Aug 6, 2026
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Recovery of hand function following nerve grafting and transfer in obstetric brachial plexus lesions
Willem Pondaag1, Martijn J A Malessy
1Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands. w.pondaag@lumc.nl
Insights
Restoring hand function is crucial for infants with obstetric brachial plexus lesions (OBPLs). Surgical repair achieved useful hand function in 69% of patients, highlighting its importance in treating flail arm injuries.
Area of Science:
- Pediatric Surgery
- Neurology
- Orthopedics
Background:
- Obstetric brachial plexus lesions (OBPLs) often require surgical intervention.
- While shoulder and biceps function outcomes are well-documented, hand function recovery data post-nerve repair is limited.
- Approximately 15% of infants with OBPLs experience impaired hand function.
Purpose of the Study:
- To present a surgical strategy focused on restoring hand function in infants with OBPLs.
- To analyze surgical methods and outcomes to identify factors influencing functional recovery.
- To emphasize hand function restoration as a primary goal in OBPL nerve repair.
Main Methods:
- Retrospective review of 33 patients undergoing surgery for flail arm over 10 years.
- Nerve repair performed at a mean age of 4.4 months.
- Analysis of 16 patients with sufficient follow-up (mean 50 months), categorized by nerve discontinuity (Group 1) versus nerve preservation (Group 2).
Main Results:
- Useful hand function (Raimondi grade ≥3) was achieved in 69% (9/13) of Group 1 patients with complete nerve discontinuity.
- In Group 2, where nerve grafts were limited, 33% (1/3) of patients achieved useful hand function.
- Surgical reconstruction was directly attributed to hand reanimation in successful cases.
Conclusions:
- Restoration of useful hand function was achieved in 69% of patients through the presented surgical strategy.
- Prioritizing hand function restoration should be the primary goal in nerve repair for OBPL-induced flail arm.
- Further research is needed to determine optimal surgical strategies for diverse OBPL lesion types.
Object:
Infants with obstetric brachial plexus lesions (OBPLs) commonly undergo surgical repair. Outcome data have been documented extensively for shoulder and biceps function, but information on hand function following nerve repair is limited. Hand function is impaired in approximately 15% of patients. The authors present a surgical strategy aimed primarily at restoration of hand function and analyze their methods and outcome to determine specific factors affecting functional recovery.
Methods:
Surgical strategy and outcome data were reviewed for 33 patients who underwent surgery for flail arm during a 10-year period. Nerve repair was performed at a mean age of 4.4 months. In 16 patients, the period of follow up (mean 50 months) was considered sufficiently long for final analysis. Of these 16 patients, 13 (Group 1) had complete discontinuity of the C-7, C-8, and T-1 spinal nerves. In three patients (Group 2), the C-8 and/or T-1 nerve was left in place because of shortage of nerve grafts or limited availability of proximal donor stumps. Postoperatively, a Raimondi hand function grade of 3 or higher was attained by nine of the 13 patients in Group 1 (69%) and one of the three patients in Group 2 (33%).
Conclusions:
Useful hand function was restored in 69% of the patients in the presented series in whom reanimation of the hand could be fully attributed to the surgical reconstruction. The authors conclude that restoration of hand function should be the first goal of nerve repair in infants with a flail arm caused by an OBPL, but that the optimal strategy for different types of lesion remains to be determined.
