Surgical Repair of Obstetric Brachial Plexus Injuries: A Case Series and Discussion of the Current Literature
Justin J Taylor1, Collin E Hoggard1, Christopher A Gegg2
1Department of Surgery, University of Central Florida College of Medicine, Orlando, Florida, USA.
Insights
Brachial plexus reconstruction improves function in obstetric brachial plexus injury (OBPI) patients lacking spontaneous recovery. However, optimal surgical timing and predicting outcomes for severe injuries require further study.
Area of Science:
- Pediatric Neurosurgery
- Orthopedic Surgery
- Nerve Reconstruction
Background:
- Obstetric brachial plexus injury (OBPI) can lead to significant upper extremity dysfunction.
- Surgical reconstruction is considered for cases with no spontaneous recovery.
Purpose of the Study:
- To evaluate factors influencing surgical success in brachial plexus reconstruction for OBPI.
- To identify predictors of outcome following this procedure.
Main Methods:
- Retrospective chart review of 27 patients undergoing brachial plexus reconstruction for OBPI.
- Analysis of preoperative function, intraoperative findings, and postoperative outcomes.
- Use of Mallet grades to assess upper trunk function (abduction, external rotation, hand-to-mouth).
Main Results:
- All patients had intraoperative evidence of upper-trunk injury.
- 17 out of 22 analyzed patients showed improvement in Mallet grades post-surgery.
- Significant improvements were observed in abduction, external rotation, and hand-to-mouth function (P < 0.001).
Conclusions:
- Brachial plexus reconstruction is effective for OBPI patients without spontaneous recovery.
- Optimal age for surgery remains undetermined.
- More severe intraoperative injuries may correlate with poorer surgical outcomes.
Objective:
To assess factors which may influence surgical success following brachial plexus reconstruction for obstetric brachial plexus injury (OBPI).
Methods:
We retrospectively reviewed the charts of 27 consecutive patients who underwent brachial plexus reconstruction following OBPI by a single pediatric neurosurgeon, 22 of which had adequate follow-up be included in analysis. Data on preoperative function, intraoperative findings, and postoperative outcomes were collected. Mallet grades for abduction, external rotation, and hand-to-mouth were used as a measure of upper trunk function.
Results:
All patients undergoing brachial plexus reconstruction (n = 27) were found to have some degree of upper-trunk injury intra-operatively. Of the 22 patients with adequate follow-up to be included in the analysis, 17 had some degree of improvement in Mallet grade postoperatively. Prior to surgery, 95% (21/22) of patients had an abduction Mallet grade of 1, compared to 23% (5/22) at the time of maximum improvement (P < 0.001). These values were 100% (20/20) to 35% (5/14) (P < 0.001), and 95% (21/22) to 27% (6/22) (P < 0.001) for external rotation and hand-to-mouth, respectively. The average time to maximum Mallet grade was 583 days (standard deviation 356 days). Age at time of surgery and time to maximum recovery were not found to be correlated.
Conclusions:
Brachial plexus reconstruction is an effective treatment modality for patients without spontaneous recovery of upper extremity function following OBPI, although identifying the optimal age-range for surgery remains elusive. Patients with intraoperative findings consistent with a more severe injury may be less likely to benefit from surgery.
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