The outcome of primary brachial plexus reconstruction in extended Erb\u2019s obstetric palsy when two roots are available for intraplexus neurotization

Mohammad M Al-Qattan,Amel A.F El-Sayed

doi:10.1007/s00238-016-1267-6

Abstract

BackgroundThe outcome of primary brachial plexus reconstruction in extended Erb’s obstetric palsy with single root avulsion has not been specifically documented in the literature.MethodsA series of 46 consecutive cases of extended Erb’s obstetric palsy with single root avulsion was retrospectively reviewed. The upper and middle trunks were reconstructed with nerve grafts from the available two roots. No nerve transfers were used. The percentage of a satisfactory motor recovery was documented.ResultsThe postoperative motor recovery was excellent (over 97%) satisfactory outcome for elbow flexion, elbow extension, and digital extension. A satisfactory wrist extension was noted in 84.8% of children. The lowest rates of satisfactory outcomes were for shoulder external rotation (65.2%) and shoulder abduction (56.5%).ConclusionsIn extended Erb’s obstetric palsy with single root avulsion, two ruptured roots are available for intraplexus neurotization of the upper and middle trunks. The surgeon gives a priority to elbow flexion and this is translated in an excellent outcome for elbow flexion. The triceps and digital extensors get a major contribution form the unaffected C8 root, and this is also translated in an excellent outcome for these two functions. Fewer cable grafts are available for reconstruction of the posterior division of upper trunk and the middle trunk, resulting in a lower rate of satisfactory outcomes at the shoulder for wrist extension.Level of Evidence: Level IV, therapeutic study.

Highlights

There are several studies [1,2,3,4,5,6] in the literature on the results of primary reconstruction of the brachial plexus in obstetric brachial plexus palsy (OBBP), the results of extended Erb’s obstetric palsy with single root avulsion has not been investigated.In extended Erb’s obstetric palsy with single root avulsion, the remaining two roots are available for intraplexus neurotization
Forty-six consecutive infants with unilateral extended Erb’s palsy and single root avulsion were included in the study
The remaining cable grafts were distributed to the posterior division of the upper trunk and the middle trunk

Summary

Introduction

There are several studies [1,2,3,4,5,6] in the literature on the results of primary reconstruction of the brachial plexus in obstetric brachial plexus palsy (OBBP), the results of extended Erb’s obstetric palsy with single root avulsion has not been investigated.In extended Erb’s obstetric palsy with single root avulsion, the remaining two roots are available for intraplexus neurotization. The senior author’s reconstructive strategy in these cases has been the same over the last two decades of practice. In these cases, the upper and middle trunks (including the suprascapular nerve) are reconstructed with sural nerve cable grafts (utilizing the two available roots) without the use of any nerve transfers. The main aim of the current article is to report on the results of a series of extended Erb’s obstetric palsy with single root avulsion treated only with intraplexus neurotization. The outcome of primary brachial plexus reconstruction in extended Erb’s obstetric palsy with single root avulsion has not been documented in the literature. The upper and middle trunks were reconstructed with nerve grafts from the available two roots.

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