Surgical treatment of obstetric brachial plexus palsy

Objektive: Obstetrical brachial plexus palsy occurs at a frequency of 0.6-2.5 per 1000 births. 80-95% of these lesions recover spontaneously. Should spontaneous recovery not occur within the first 6 months of life, electrophysiological examination CT-Myelography, and surgical exploration of the brachial plexus are recommended. Methods: Seven children who had obstetrical brachial plexus palsies were operated over a five year period among 99 operations of traumatic brachial plexus injuries. In 617 children we found nerve root avulsions. In two cases we performed a neurotisation, in four nerve grafting after neuroma excision and in one an external neurolysis of the brachial plexus. Results: So far, we only have a long-term follow-up in 3/7 children (26-42 months). All these children showed clinically regeneration of grafted nerves. Full recovery of the brachial plexus lesions was limited because of concomitant nerve root avulsions. Conclusion: We recommend decision for surgery at the age of 6-9 months. Physical therapy and options including muscle transfers and orthopedic procedures must be available to ensure the optimal outcome for these children.