Oberlin Procedure in Concomitant With Anterior Shoulder Release in Management of Upper Obstetric Brachial Plexus Palsy

Abstract

Objective: Describe a new procedure that combines Oberlin procedure with concomitant shoulder realise in Upper Obstetric Brachial Plexus Palsy. Methods: We present 18 children with upper obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve in concomitant with anterior shoulder release. Eight were males, and 10 were females. The left-side brachial plexus was affected in 11 patients and the right side in 7 patients. Sixteen children had vaginal delivery and 2 children were delivered by cesarean section. The average birth weight was 3800 g (range, 3430-6000 g). Average age at the time of operation was 18 months (range, 12-26 months). The indication for the operation was absent active elbow flexion and no shoulder abduction with internal rotation contracture deformity. Oberlin’s ulnar nerve transfer was done in all cases in concomitant with anterior shoulder release without brachial plexus exploration. Results: The average follow-up was 18 months (range, 12-58 months). Nine children had biceps muscle M5, 6 of them had biceps muscle M4, and 3 children had <M3. Twelve children gained full shoulder abduction and 6 of them gained less than 120° shoulder abduction. Conclusion: We recommend Oberlin’s ulnar nerve transfer in concomitant with anterior shoulder release for upper-type obstetric brachial plexus palsy in children who have neither elbow flexion nor shoulder abduction with internal rotation contracture deformity in late presentation.