Nerve transfers in children with traumatic partial brachial plexus injuries

Area of Science:

• Pediatric Surgery
• Neurology
• Orthopedics

Background:

• Brachial plexus trauma is uncommon in children, with obstetrical lesions being the most frequent cause.
• Nerve grafting is the usual treatment for such injuries, but nerve transfers present an alternative.
• This study focuses on traumatic C5 and C6 brachial plexus avulsion lesions in pediatric patients.

Observation:

• Two pediatric patients (ages 9 and 12) with traumatic brachial plexus avulsion (C5 and C6) were treated.
• The primary goal was to restore elbow flexion, shoulder abduction, and external rotation.
• Specific nerve transfers were performed, including accessory-to-suprascapular, triceps to axillary, and ulnar/median nerve fascicle transfers.

Findings:

• Both patients achieved M4 elbow flexion and recovered shoulder abduction at an 11-month follow-up.
• The surgical interventions demonstrated effectiveness in restoring key upper extremity functions.
• No complications were reported following the nerve transfer procedures.

Implications:

• Nerve transfers, a technique commonly employed in adult brachial plexus injuries, are applicable and effective in children.
• This study suggests nerve transfers as a viable treatment option for traumatic partial brachial plexus palsies in pediatric populations.
• The findings support expanding the use of nerve transfers for pediatric nerve reconstruction, potentially improving functional outcomes.