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Elbow Flexion after Primary Reconstruction in Obstetric Brachial Plexus Palsy

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School, Norfolk, Virginia, USA

Correspondence: Terzis K. Julia, MD, PhD, Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School (EVMS), 700 Olney Road, LH 2055, Norfolk, VA 23501, USA. Tel.: +1-757-446-5272; fax: +1-757-446-5109. E-mail:mrc{at}jkterzis.com.

Fifty-two children (54 upper extremities) with obstetric brachial plexus palsy who underwent primary reconstruction for elbow flexion restoration were studied. The outcomes were analysed in relation to the type of brachial plexus lesion, timing of surgery, and the type of reconstruction. Overall, 42 of 54 extremities (78%) achieved good and excellent results (M3+). The average postoperative muscle grading for the biceps was 3.7 (SD 0.8), and the average postoperative active elbow flexion was 108° (SD 33°). The average elbow flexion contracture was 18° (SD 21°). The timing of surgery and the type of the brachial plexus injury significantly influenced the final outcome. The best results were seen in early cases (3 months), where the lateral cord was reconstructed from intraplexus donors. In this group, minimal flexion contracture deformity was observed. Late reconstruction (7 months) of the musculocutaneous nerve resulted in inferior results.

Key Words: birth palsy • elbow flexion • musculocutaneous nerve • primary reconstruction

This version was published on August 1, 2009

Journal of Hand Surgery (European Volume), Vol. 34, No. 4, 449-458 (2009)
DOI: 10.1177/1753193409105188


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