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Management of Brachial Plexus Birth Injuries at British Columbia Children's Hospital
Cynthia Verchere1,2, Kim Durlacher3, Doria Bellows4
1Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Insights
The Sup-ER protocol, using a shoulder orthosis for brachial plexus birth injuries, improved patient shoulder outcomes and reduced the need for surgery. This innovative approach also decreased elbow flexion contractures in neonates.
Area of Science:
- Pediatric Orthopedics
- Neonatal Care
- Brachial Plexus Injury Management
Background:
- Brachial plexus birth injuries present significant challenges in neonatal care.
- Effective management strategies are crucial for optimizing long-term shoulder and arm function.
- Previous treatment protocols at BC Children's Hospital had limitations.
Purpose of the Study:
- To evaluate the efficacy of the newly developed Sup-ER protocol for brachial plexus birth injury management.
- To assess the impact of the Sup-ER protocol on shoulder outcomes, surgical interventions, and contracture development.
- To compare outcomes of the Sup-ER protocol with historical treatment data.
Main Methods:
- Implementation of the Sup-ER protocol, incorporating a passive shoulder positioning orthosis for neonates.
- Multidisciplinary team approach for brachial plexus birth injury management.
- Retrospective comparison of patients treated with the Sup-ER protocol versus pre-protocol patients.
Main Results:
- Patients managed with the Sup-ER protocol demonstrated improved shoulder outcomes.
- Significant reduction in the need for brachial plexus surgery and shoulder tendon transfers.
- Lower rates and degrees of elbow flexion contractures compared to literature benchmarks.
Conclusions:
- The Sup-ER protocol is an effective intervention for brachial plexus birth injuries.
- This protocol leads to better functional outcomes and fewer secondary surgical procedures.
- The Sup-ER protocol shows promise in mitigating common complications like elbow flexion contractures.
Abstract:
A multidisciplinary team at BC Children's Hospital provides brachial plexus birth injury management for our provincial catchment area. Although compared with many centers we service a relatively small clinic population, we have the benefit of universal health care, province-wide reach, and accessible research infrastructure. In 2008, we created the Sup-ER protocol, which includes an orthosis that passively positions the neonatal shoulder into more idealized glenohumeral contact during early growth. We have since shown that our Sup-ER patients have better shoulder outcomes, require less brachial plexus surgery, and need fewer shoulder tendon transfers than those patients treated in our clinic prior to 2008. We have also found that the rate and degree of elbow flexion contractures are reduced compared with results reported in the literature.
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