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Treatment of obstetrical brachial plexus palsy sequelae: Preliminary results about 18 cases
Badara Diop1, Mohamed Daffe2, Badara Dembele2
1Department of Surgery, Gaston Berger University, Saint-Louis, Senegal.
Insights
Surgical management of obstetrical brachial plexus palsy sequelae improved limb function. Procedures like shoulder release and tendon transfers enhanced shoulder rotation, abduction, and wrist extension in pediatric patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Neurology
Background:
- Obstetrical brachial plexus palsy (OBPP) causes significant upper limb functional handicap due to paralysis.
- Early and effective management is crucial for improving long-term outcomes.
Purpose of the Study:
- To assess the preliminary results of surgical interventions for sequelae of obstetrical brachial plexus palsy.
- To evaluate the functional recovery in pediatric patients after various surgical procedures.
Main Methods:
- A prospective study of 18 pediatric patients (average age 7.7 years) with OBPP sequelae.
- Surgical techniques were tailored to palsy type (Narakas classification). Procedures included anterior shoulder release, latissimus dorsi transfer, biceps rerouting, osteotomies, and tendon transfers.
- Patient outcomes were assessed using Mallet, Gilbert-Raimondi, Brachial plexus World Group Heerlen, and Raimondi scores.
Main Results:
- Significant improvements were observed in active external shoulder rotation (from -22.5° to 38.8°) and active abduction (from 78.3° to 141.1°) in patients with Narakas groups I and II.
- In Narakas group III, spontaneous supination improved from 75.5° pronation to 45° supination.
- Tendon transfers in the wrist and hand resulted in improved active wrist extension (0° to 45° and -60° to 0°).
Conclusions:
- Palliative surgical interventions play a vital role in restoring upper limb function in cases of obstetrical brachial plexus palsy sequelae.
- The study demonstrates the efficacy of tailored surgical approaches in improving functional deficits associated with OBPP.
Background:
Severe obstetrical injuries of the brachial plexus lead to a complete or incomplete paralysis resulting in a significant functional handicap of the limb.This study aimed to assess the preliminary results of our management.
Materials And Methods:
This prospective study involved 18 patients, with an average age of 7.7 years. The choice of the surgical technique depended on the type of palsy. We evaluated our patients using the Mallet, Gilbert-Raimondi, Brachial plexus World Group Heerlen, and Raimondi scores.
Results:
Patients in groups I and II of Narakas had an anterior shoulder release (n = 2) and transfer of the latissimus dorsi (n = 8). For those in group III, we performed 5 biceps rerouting and 2 radius derotation osteotomies, one of which was associated with a Zancolli I and an arthrodesis of the thumb MCP joint. In the wrist and hand, we performed two tendon transfers from the flexor carpi ulnaris to the extensor tendons of the fingers.After a mean follow-up of 30.52 months, in the first 9 patients, active external rotation of the shoulder increased from a mean value of -22.5°-38.8° and mean active abduction from 78.3° to 141.1°. In Group III, the mean spontaneous supination position of 75.5° was improved to 45° pronation. Regarding the two patients with tendon transfers, active wrist extension increased from 0° to 45° and from -60° to 0°, respectively.
Conclusion:
Palliative surgery in the treatment obstetrical brachial plexus palsy sequelae retains an important place in the restoration of upper limb function.
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