Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
Anna Boesendorfer1, Agnes Sturma1,2, Clemens Gstoettner1,3
1Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
Insights
Bionic reconstruction, involving amputation and prosthetic fitting, can significantly improve hand function for adults with severe obstetric brachial plexus injuries (OBPI). This approach offers a viable solution when traditional methods fail to restore meaningful hand use.
Area of Science:
- Orthopedics
- Neuroscience
- Rehabilitation Medicine
Background:
- Severe obstetric brachial plexus injuries (OBPI) in adults often result in profound upper extremity and hand-arm dysfunction.
- Traditional reconstructive surgeries and therapies frequently fail to restore functional hand use in these cases.
- Limited options exist for adults with severe OBPI to regain functional independence.
Observation:
- A 27-year-old adult with a unilateral OBPI and minimal hand function underwent bionic reconstruction.
- The patient received an elective amputation, de-rotation osteotomy, and prosthetic fitting with a myoelectric prosthesis.
- Interdisciplinary evaluation, including psychosocial assessment, determined eligibility for the procedure.
Findings:
- Post-prosthetic fitting, the patient showed significant functional improvements: ARAT scores increased from 12 to 20, SHAP scores from 8 to 29, and DASH scores decreased from 50 to 11.7.
- The patient achieved substantial independence in daily activities.
- The prosthesis was used for 5-6 hours daily, 4-5 days a week.
Implications:
- Bionic reconstruction is a viable treatment option for selected adults with severe OBPI and unsatisfactory biologic hand function.
- This approach can lead to solid hand function and improved independence in daily activities.
- Further research into bionic reconstruction for OBPI patients is warranted.
Abstract:
Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient. Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed. Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4-5 days a week). Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.
