Analysis of Results of Contralateral Hemi-C7 Root Used for Restoring Hand Function in Global Birth Brachial Plexus Palsy

Abstract

To analyze the outcome of the use of contralateral hemi-C7 for the restoration of hand function in patients with birth brachial plexus global palsy. From 2004 to 2017, 19 infants with Narakas types III and IV birth brachial plexus palsy underwent transfer of contralateral hemi-C7 (posterior division of the contralateral C7 root) to the lower trunk or medial cord on the affected side. All the patients were evaluated for shoulder function using the Gilbert and Mallet scores, elbow flexion using the modified Medical Research Council score for children, and hand function using the Raimondi score. After the surgery, the children were followed-up at 3-month intervals for the first year and6-month intervals thereafter. Hand function achieving Raimondi scores of 3-5 was considered a useful outcome. The patients were followed-up for a mean duration of 88 months, with a minimum of 35 and a maximum of 192 months of follow-up. All patients attained a Gilbert score of ≥3, whereas 9 patients attained a score of ≥4. Similarly, all patients attained a minimum aggregate Mallet score of 15, and 9 patients attained a score of ≥20. All patients attained a modified Medical Research Council score of ≥3, used for assessing elbow flexion. Useful hand function was attained in 73% (14/19) of the cases (a Raimondi score of ≥3). There was no clinically recorded deficit on the donor side. Contralateral hemi-C7 transfer in infants with brachial plexus root avulsions helped regain useful hand function in 73% (14/19) of the children treated. Therapeutic IV.