Duchenne-Erb palsy. Experience with direct surgery.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Traumatology

Background:

• Traumatic Duchenne-Erb palsy, involving C5 and C6 nerve roots, presents significant challenges in motor function recovery.
• Direct surgical exploration is a key approach for assessing and treating these complex brachial plexus injuries.

Purpose of the Study:

• To evaluate the efficacy of surgical interventions, including neurolysis and nerve grafting, for traumatic Duchenne-Erb palsy.
• To determine the impact of timing and technique on functional recovery in patients with C5 and C6 nerve root lesions.

Main Methods:

• Retrospective analysis of 31 direct surgical explorations for traumatic Duchenne-Erb palsy (C5-C6) between 1973 and 1984.
• Comparison of outcomes following simple neurolysis versus nerve grafting procedures.
• Statistical correlation of functional results with the number of grafts and delay in surgical intervention.

Main Results:

• Neurolysis yielded useful motor function in 9 of 12 cases where C5 and C6 were in continuity, though causality was uncertain.
• Nerve grafting in cases with single root damage resulted in useful motor function in 4 out of 5 instances.
• In complete C5-C6 lesions, nerve grafting achieved functional motor results in 7 of 14 cases, with outcomes correlating with the number of grafts (p<0.01).
• Optimal results were observed with nerve grafting within five months; delays exceeding nine months yielded unfavorable outcomes.

Conclusions:

• Both neurolysis and nerve grafting can be effective in restoring motor function in traumatic Duchenne-Erb palsy.
• Early nerve grafting, ideally within five months, is crucial for maximizing functional recovery in severe brachial plexus injuries.
• The number of grafts used in repair is a significant predictor of overall and elbow flexion recovery.