[Early results of nerve surgery in obstetrical brachial plexus palsy].

OBJECTIVES: To present surgical techniques and early postoperative results of patients who underwent nerve surgery for obstetrical brachial plexus palsy.

METHODS: Twenty-four infants (12 girls, 12 boys; mean age 7.9 months; range 4 to 14 months) with obstetrical brachial plexus palsy underwent nerve repair following a surgical algorithm that showed inadequate spontaneous nerve regeneration and muscle function. Neurolysis was performed in five cases, intraplexial neurotisation in 17 cases, and extraplexial transfer of the spinal accessory nerve to the suprascapular nerve in seven cases. Seventeen patients (70%) had total palsy (C5, C6 and/or C7 rupture and C8, T1 avulsion), four patients (17%) had C5, C6 involvement, and three patients (13%) had C5-7 involvement. Pre- and postoperative evaluations were made according to the grading system of the Hospital for Sick Children (HSC). The mean follow-up period was 15.8 months (range 8 to 31 months).

RESULTS: The mean HSC grades of the patients followed at least for 12 months were as follows: shoulder abduction 4, elbow flexion 4.5, wrist extension 2.3, and finger flexion 3.3. Compared to patients who underwent neurolysis alone, improved nerve regeneration was noted in patients who underwent neuroma excision and nerve grafting. No severe complications occurred postoperatively, including respiratory problems, metabolic acidosis, and hypothermia.

CONCLUSION: Early diagnosis and nerve surgery in patients having insufficient muscle activity and requiring surgical intervention may prevent atrophy of the muscles and provide a more functional upper extremity.