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Evaluation of surgical outcomes of obstetric brachial plexus birth injury: clinical and electrophysiological study
Egyptian Rheumatology and Rehabilitation volume 46, pages 229–236 (2019)
Abstract
Background
Obstetric brachial plexus birth injury (OBPBI) is a relatively common form of birth injury that might lead to a weighty physical disability. Early microsurgical intervention for properly selected patients will result in maximal functional benefit that couldn’t be otherwise obtained. However, the outcomes of different microsurgical techniques need to be further evaluated and compared.
Aim
To evaluate the outcomes of different microsurgical techniques performed in patients with OBPBI.
Patients & Methods
Twenty-eight patients with OBPBI meeting the criteria for surgical intervention were included in the study. Preoperative and one year postoperative clinical and electrophysiological assessments were done.
Results
Thirteen (46.4%) of the studied patients were males and 15 (53.6%) were females. The mean age of patients in the study was 8.64 months ± 4.40; ranging between (3.0 – 16.0 months),7 patients had Horner syndrome.C5 and C6+/-C7 roots affection was the most frequent lesion ,patients who underwent neurotization recovered earlier than patients who underwent nerve grafting ,on the other hand nerve grafting resulted in more significant postoperative improvement after a 12 months follow up period.
Conclusions
The current study provided additional evidence that the earlier the surgical intervention in OBPBI, the better the outcomes. Neurotization results in earlier functional recovery in patients with OBPBI than nerve grafting reconstructive techniques. On the other hand, nerve grafting was superior to neurotization regarding the degree of improvement. Postoperative electrophysiological follow-up can be done using the CMAP amplitude and AUC percentages reflecting the percentage of viable axons.
References
Chim H, Bishop AT, Spinner RJ, Shin AY. Traumatic brachial plexus injury in the pediatric population. In Abzug JM, Kozin S, Zlotolow D, eds. The pediatric upper extremity. New York: Springer-Verlag 2015. 685–688
Curtis C, Stephens D, Clarke HM, Andrews D. The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg Am 2002; 27:470–478.
Ferrante MA. Brachial plexopathies: classification, causes, and consequences. Muscle Nerve 2004; 30:547–568.
Ferrante MA. Electrodiagnostic assessment of the brachial plexus. Neurol Clin 2012; 30:551–580.
Swan MC, Clarke HM. Microsurgery for obstetrical brachial plexus palsy. In Abzug JM, Kozin SH, Zlotolow DA eds. The pediatric upper extremity. New York, NY: Springer New York 2015. 607–631
Al-Qattan MM. The outcome of Erb’s palsy when the decision to operate is made at 4 months of age. Plast Reconstr Surg 2000; 106:1461–1465.
Gilbert A, Pivato G, Kheiralla T. Long-term results of primary repair of brachial plexus lesions in children. Microsurgery 2006; 26:334–342.
Andersen J, Watt J, Olson J, Van Aerde J. Perinatal brachial plexus palsy. Paediatr Child Health 2006; 11:93–100.
Heise CO, Lorenzetti L, Marchese AJ, Gherpelli JL. Motor conduction studies for prognostic assessment of obstetrical plexopathy. Muscle Nerve 2004; 30:451–455.
Van Dijk JG, Pondaag W, Malessy MJ. Obstetric lesions of the brachial plexus. Muscle Nerve 2001; 24:1451–1461.
Alfonso I, Papazian O, Grossman JA. Clinical presentations, differential diagnosis and management of obstetric brachial palsy. Rev Neurol 1998; 27:258–263.
Preston DC, Shapiro BE. Electromyography and neuromuscular disorders e-book: clinical-electrophysiologic correlations (expert consult-online) USA: Elsevier Health Sciences 2012.
Foad S, Mehlman C, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. Am J Bone Jt Surg 2008; 90:1258–1264.
Volpe KA, Snowden JM, Cheng YW, Caughey AB. Risk factors for brachial plexus injury in a large cohort with shoulder dystocia. Arch Gynecol Obstet 2016; 294:925–929.
Michelow B, Clarke H, Curtis C. The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg 1994; 93:675–680.
McFarland LV, Raskin M, Daling JR, Benedetti TJ. Erb/Duchenne’s palsy: a consequence of fetal macrosomia and method of delivery. Obstet Gynecol 1986; 68:784–788.
Al Shishtawy NI. Prediction of functional outcome of obstetric brachial plexus palsy. Egypt Rheumatol Rehab 2003; 30:625–632.
Siqueira M, Heise C, Alencar G, Martins R, Foroni L. Outcomes from primary surgical reconstruction of neonatal brachial plexus palsy in 104 children. Child Nerv Sys 2019; 35:349–354.
Garg R, Merrell GA, Hillstrom HJ, Wolfe SW. Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. J Bone Joint Surg Am 2011; 93:819–829.
Al-Qattan MM. Oberlin’s ulnar nerve transfer to the biceps nerve in Erb’s birth palsy. Plast Reconstr Surg 2002; 109:405–407.
Noaman HH, Shiha AE, Bahm J. Oberlin’s ulnar nerve transfer to the bíceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results. Microsurgery 2004; 24:182–187.
Chuang DC, Mardini S, Ma HS. Surgical strategy for infant obstetrical brachial plexus palsy: experiences at Chang Gung Memorial Hospital. Plast Reconstr Surg 2005; 116:132–142.
Heise CO, Siqueira MG, Martins RS, Foroni LH, Sterman-Neto H. Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement. Childs Nerv Syst 2017; 33:1571–1574.
Sarac C, Duijnisveld BJ, van der Weide A, Schoones JW, Malessy MJ, Nelissen RG, et al. Outcome measures used in clinical studies on neonatal brachial plexus palsy: a systematic literature review using the International Classification of Functioning, Disability and Health. J Pediatr Rehabil Med 2015; 8:167–185.
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Mohasseb, D.F., Hassan, M.M., Semaya, A.E. et al. Evaluation of surgical outcomes of obstetric brachial plexus birth injury: clinical and electrophysiological study. Egypt Rheumatol Rehabil 46, 229–236 (2019). https://doi.org/10.4103/err.err_4_19
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DOI: https://doi.org/10.4103/err.err_4_19