Back to 2012 Annual Meeting Program
Hand Outcomes in Operative Management of Complete Obstetrical Brachial Plexus Palsy
Isaac Harvey, FRACS, MBBS, BSc1, Emily Ho2, MD; Howard Clarke1, MD
1Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Ontario, ON, Canada, 2Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada
Aim: To report the long term outcomes in relation to hand function in patients undergoing lower trunk reconstruction in the setting of complete resection for neuroma, rupture or avulsion of all five roots. To compare these results with those published from other centres on hand outcomes in complete plexus palsy.
Methods: A retrospective review of prospectively collected data was performed using the Hospital for Sick Children Brachial Plexus Database. Of 1432 patients assessed with OBPP between 1988 and 2010, 54 patients underwent primary nerve reconstruction of the lower trunk. Data points of 4 and 8 years post operatively were used. Results are reported as Active Movement Scale (AMS) scores and conversion is made to Raimondi hand scores using a comparison table we have constructed. Results for function are reported using the Brachial Plexus Outcome Measure (BPOM) scale.
Results: After exclusion criteria 40 patients had sufficient follow up of a minimum of 4 years. AMS scores are reported for the 8 recorded movements that are directly related to hand function. The percentage of patients achieving an AMS score of 3 or greater for Pronation 30%, Supination 67.5%, Wrist flexion 80%, Wrist extension 30%, Finger Flexion 92.5%, Finger Extension 42.5%, Thumb Flexion 82.5%, Thumb Extension10%. Using a conversion table, the percentage of patients with Raimondi scores 1 - 0%, 2a - 27.5% 2b – 20%, 3 – 37.5%, 4 – 5%, 5 – 10%. At 8 years post surgery over 90% of patients had BPOM scores of 3 or greater (indicating a functionally useful hand) for each of the tasks directly related to hand function.
Discussion: Functionally useful hands are a realistic goal in primary reconstruction of the lower trunk in obstetrical brachial plexus palsy. Direct comparison between AMS and Raimondi scores is difficult due to literal translation of descriptive words in the Raimondi scale into Numerical values used on the AMS and vice versa. 80% of patients score wrist flexion greater than 3 and 92.5% of patients score finger flexion of greater than 3 on the AMS. Despite this only 52.5% of patients after conversion have a Raimondi score of 3 or greater. Perhaps more importantly than these scores, over 90% of patients score 3 or greater on the BPOM indicating the vast majority of patients undergoing reconstruction of the lower trunk are able to achieve useful function from their reconstructed hand.
Back to 2012 Annual Meeting Program