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Recovery of Hand Function After Surgical Reconstruction of Brachial Plexus in OBPP
Mohamed Mostafa Kotb, MD
Hand and Recosntructive Microsurgery Unit, Orthopedic Deprtment, Assiut University Hospital, Assiut, Egypt
Introduction: Obstetric brachial plexus palsy (OBPP) is an injury with deleterious medical, psychological and socioeconomic sequelae both for the patient and his or family. The loss of feeling or the simplest God-given skills such as muscle control in an infant's arm and hand can affect families for an entire lifetime.
Patients and methods: 43 patients with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The distribution of the patients between the two genders was almost equal, with 22/43 males (51.1%) and 21 females (48.9%). The right side was affected in 27 (62.7%) cases and left side in 15 (35.3%) cases. Bilateral affection was noticed in 1 (2.3%) case in which the left side was treated conservatively and the other side was explored surgically. The Mean age at surgery was 15.8 months (3-96 months). The mean follow-up period was 3.7 years. Surgical procedures included neurolysis; neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostal nerves and cross neck C7 root. Nerve suture was done in all cases using 10/0 Nylon suture. Evaluatinon of hand function using the Toronto scale, Raimondi grading system and Limb integration into the normal daily activities
Results: Satisfactory recovery was obtained in 61.1% for finger flexion; 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi scoring system, out of 32 cases 16 achieved a score of 3 or more (functional hand), 16 cases had a score of 2 or less. As regards limb integration into the normal daily activities 3 cases were poor, 8 cases were fair, 14 were good and 8 were excellent. Limb integration did not significantly correlate with any of the regained upper limb functions except a positive significant correlation with shoulder external rotation.
Summary and conclusion: Supra and infra clavicular explorations should be conducted in every case for possible existence of double level lesion. In total palsy the earlier the intervention the better the results. Apparently intact C8 and T 1 root should be left alone if the patient has partial recovery, no horner sign and was operated early enough ( 3 or 4 month age). An apparently intact non functioning root with no positive response to electrical stimulation and especially in the presence of Horner syndrome should be neurotized with the best available intraplexal donor.
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