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Elbow flexion after primary reconstruction in obstetric brachial plexus palsy

J K Terzis1, Z T Kokkalis

  • 1Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School, Norfolk, Virginia 23501, USA. mrc@jkterzis.com

The Journal of Hand Surgery, European Volume
|July 10, 2009
PubMed

Insights

Early surgical reconstruction for obstetric brachial plexus palsy yields optimal elbow flexion outcomes. Timely intervention, particularly before 3 months, significantly improves results and minimizes contractures.

Area of Science:

  • Pediatric Orthopedics
  • Neurology
  • Surgical Reconstruction

Background:

  • Obstetric brachial plexus palsy (OBPP) affects nerve function in infants, impacting arm movement.
  • Restoring elbow flexion is crucial for functional recovery in children with OBPP.
  • Surgical reconstruction aims to improve muscle grading and active range of motion.

Purpose of the Study:

  • To analyze outcomes of primary reconstruction for elbow flexion in OBPP.
  • To identify factors influencing surgical success, including lesion type and timing.
  • To compare different reconstruction techniques for optimal results.

Main Methods:

  • Retrospective study of 52 children (54 upper extremities) with OBPP undergoing primary reconstruction.
  • Outcomes assessed based on muscle grading, active elbow flexion, and contracture.
  • Analysis correlated results with brachial plexus lesion type, surgery timing, and reconstruction method.

Main Results:

  • 78% of extremities achieved good to excellent results (>=M3+).
  • Average postoperative biceps muscle grading was 3.7; active elbow flexion averaged 108 degrees.
  • Early reconstruction (<3 months) with lateral cord repair showed superior outcomes and minimal contractures.
  • Late reconstruction (>=7 months) of the musculocutaneous nerve yielded poorer results.

Conclusions:

  • Timing of surgery and type of brachial plexus injury significantly impact OBPP reconstruction outcomes.
  • Early intervention (<3 months) with intraplexus donor reconstruction is recommended for optimal elbow flexion.
  • Delayed reconstruction or specific nerve repairs may lead to less favorable functional recovery.

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