Abstract
Introduction. Obstetric brachial plexus injury (OBPI) occurs during the process of labor and childbirth. OBPI has been reported to be associated with shoulder dystocia, macrosomia, and breech delivery. Its occurrence in uncomplicated delivery is possible as well. Case Presentation. The patient in the present report is a 6.5-year-old girl, who suffered a severe brachial plexus injury at birth and had many reconstructive surgical procedures at an outside brachial plexus center before presenting to us. Discussion. The traditional surgical treatments by other surgical groups were unsuccessful and therefore the patient came to our clinic for further treatment. She had triangle tilt surgery with us, as a salvage procedure. Conclusion. The OBPI patient in this study clearly showed noticeable clinical and functional improvements after triangle tilt surgical management. The posture of the arm at rest was greatly improved to a more normal position, and hand to mouth movement was improved as well. Triangle tilt surgery should be conducted as a first choice treatment for medial rotation contracture of the shoulder in OBPI patients.
Highlights
Obstetric brachial plexus injury (OBPI) occurs during the process of labor and childbirth
OBPI has been reported to be associated with shoulder dystocia, [1,2,3] macrosomia [3, 4], and breech delivery [5]
The patient in the present report is a 6.5-year-old girl who was born with right side brachial plexus injury (C5–C8), weighing 9 lb 13 oz
Summary
Obstetric brachial plexus injury (OBPI) occurs during the process of labor and childbirth. OBPI has been reported to be associated with shoulder dystocia, [1,2,3] macrosomia [3, 4], and breech delivery [5]. Roughly one in 5 affected infants tends to retain persistent limb deficits, never recover full function, and develop permanent injuries [11]. The most commonly affected nerve roots of the brachial plexus are C5-6, with or without injury to the other roots, affecting any or all of the C5-T1 nerve roots. Persistent C5 nerve damage in these patients leads to muscle imbalances and bony deformities at the shoulder joint. Many traditional procedures have been described to treat obstetric brachial plexus deformity [13,14,15,16]. We report the clinical outcome of one OBPI pediatric patient, who had undergone the triangle tilt surgical procedure as a salvage procedure at our institution [17,18,19,20,21,22,23,24]
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