Arguments for a neuroorthopaedic strategy in upper limb arthrogryposis

Area of Science:

• Pediatric Orthopedics
• Neurology
• Surgical Innovation

Background:

• Arthrogryposis multiplex congenita (AMC) is a congenital disorder characterized by multiple joint contractures, often affecting the upper limbs.
• The exact etiology of AMC remains unknown and is considered multifactorial.
• Restoring upper limb function in AMC is crucial for a child's overall development and independence.

Observation:

• Two pediatric cases of upper limb arthrogryposis were analyzed.
• Brachial plexus exploration was performed in the affected upper limbs.
• Selective motor nerve transfers were identified as a potential intervention.

Findings:

• Nerve transfers to well-developed but underinnervated muscles (e.g., biceps brachialis, brachialis, deltoid, supra-/infraspinatus) were successfully performed.
• The procedure aimed to reanimate elbow flexion.
• This surgical strategy demonstrated potential for functional improvement.

Implications:

• Brachial plexus exploration and nerve transfer can be a valuable strategy in managing upper limb arthrogryposis.
• This approach may decrease the requirement for later, more extensive muscle transfer surgeries.
• Improved functional status of the affected limb(s) can be achieved, enhancing quality of life.