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Surgical strategy in extensive proximal brachial plexus palsies

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Abstract

Purpose

To describe and assess an overall surgical strategy addressing extensive proximal brachial plexus injuries (BPI).

Methods

Forty-five consecutive patients’ charts with C5–C6–C7 and C5–C6–C7–C8 BPI were reviewed. Primary procedures were nerve transfers to restore elbow function and grafts to restore shoulder function when a cervical root was available; when nerve surgery was not possible or had failed, tendon transfers were conducted at the elbow while addressing shoulder function with glenohumeral arthrodesis or humeral osteotomy. Tendon transfers were used to restore finger extension.

Results

Forty-one patients underwent elbow flexion reanimation: thirty-eight had nerve transfers and eight received tendon transfers, including five cases secondary to nerve surgery failure; grade-3 strength or greater was reached in thirty-seven cases (90%). Twenty-nine patients had nerve transfers to restore elbow extension: twenty-five recovered grade-3 or grade-4 strength (86%). Forty-one patients underwent shoulder surgery: fourteen had nerve surgery and thirty-one received palliative procedures, including four cases secondary to nerve surgery failure; thirty patients recovered at least 60° of abduction and rotation (73%). Distal reconstruction was performed in thirty-seven patients, providing finger full extension in all cases but two (95%).

Conclusions

A standardized strategy may be used in extensive proximal BPI, providing overall satisfactory outcomes.

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Acknowledgements

The authors would like to thank Julia Lee, MD, for her help with the redaction and revision of the English composition of the manuscript.

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Authors and Affiliations

Authors

Contributions

MLH contributed to conception, writing and editing. TL involved in conception, witting and editing. ACB helped with corrections, writing and editing. ZB contributed to corrections, writing and editing.

Corresponding author

Correspondence to M. Le Hanneur.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All investigations were conducted in accordance with the 1964 Declaration of Helsinki ethical standards and the MR-003 reference methodology*; the study was registered in the National Commission for the Computer Science and Liberties (Commission Nationale de l’Informatique et des Libertés—CNIL) database register (No. 2052222 v 0); and each patient was individually informed and gave his/her consent before any data collection and analysis.

* Journal Officiel de la République Française n°0189 du 14 août 2016. Texte N°77. legifrance.gouv.fr. https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000033028290&dateTexte=&categorieLien=id. Access date: 01/01/2018.

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Le Hanneur, M., Lafosse, T., Cambon-Binder, A. et al. Surgical strategy in extensive proximal brachial plexus palsies. Musculoskelet Surg 103, 139–148 (2019). https://doi.org/10.1007/s12306-018-0552-x

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  • DOI: https://doi.org/10.1007/s12306-018-0552-x

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