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Expected Outcomes of Surgical Treatment in Obstetrical Brachial Plexus Injuries

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Operative Brachial Plexus Surgery

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Abstract

Surgical techniques to restore nerve function in infants with brachial plexus birth injuries (BPBI) include nerve grafting, neurolysis, and nerve transfers. These techniques result in reliable recovery of shoulder abduction, shoulder flexion, and elbow flexion in infants with upper and middle trunk injuries who have delayed or absent nerve recovery (Gilbert et al. Microsurgery. 26(4):334–342, 2006; Lin et al. Plast Reconstr Surg. 123(3):939–948, 2009; Manske et al. Plast Reconstr Surg. 143(5):1017e–26e, 2019; Boome and Kaye, J Bone Joint Surg Br. 70(4):571–576, 1988; Pondaag et al. Neurosurgery, 57(3):530–537, 2005; Malessy, J Bone Joint Surg Am. 96(20):e174, 2014). Infants with global brachial plexus injuries, for whom reconstructive strategies include reconstruction of hand function, experience more variable results, with less robust recovery of shoulder and elbow function compared with upper and middle trunk injuries; although some recovery of hand motor function is expected, it is not clear that children recover meaningful hand use. (Gilbert and Whitaker, J Hand Surg Edinb Scotl. 16(5):489–491, 1991; Kirjavainen etal. J Bone Joint Surg Br. 90(3):349–355, 2008; Haerle and Gilbert, J Pediatr Orthop. 24(2):194–200, 2004; Pondaag and Malessy, J Neurosurg. 105(1 Suppl):33–40, 2006; Terzis and Kokkalis, Plast Reconstr Surg. 122(2):516–526, 2008; Maillet and Romana, J Child Orthop. 3(2):101–108, 2009). However, each infant’s injury is unique, and despite postoperative improvements, persistent upper extremity impairment and the need for further intervention are common in both groups (upper trunk and global palsies), regardless of surgical technique.

Many questions regarding surgical outcomes in infants with BPBI remain. Long-term, multicenter outcomes studies that follow infants into childhood and adulthood, and include patient-reported outcomes measures, will provide information that will enable providers to continue to advance the care of infants with BPBI.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Shriners Hospital for Children—Northern California, University of California, Davis, Sacramento, CA, USA

    M. Claire Manske & Michelle A. James

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Correspondence to M. Claire Manske .

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  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Alexander Y. Shin

  2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Nicholas Pulos

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Manske, M.C., James, M.A. (2021). Expected Outcomes of Surgical Treatment in Obstetrical Brachial Plexus Injuries. In: Shin, A.Y., Pulos, N. (eds) Operative Brachial Plexus Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-69517-0_53

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