The Effect of Timing on Nerve Surgery Outcomes for Obstetric Brachial Plexus Palsy
Kevin T Rezzadeh, BA1, Megan Rose Donnelly, BS2, Karen J Noh, BS2, Themistocles Stavros Protopsaltis, MD3, Andrew E. Price, MD4 and Jacques H. Hacquebord, MD2, (1)New York University School of Medicine, New York, NY, (2)NYU Langone Health, New York, NY, (3)NYU Langone Medical Center, New York City, NY, (4)Brachial Plexus Program, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
INTRODUCTION: The optimal timing for brachial plexus surgery in obstetric brachial plexus injury patients is unclear. The purpose of this study is to attempt to identify if there are any benefits to early interventions in obstetric brachial plexus injury (OBPI) patients. We hypothesize that patients that receive earlier intervention will achieve superior elbow flexion outcomes.
METHODS: A systematic review of the literature was completed by two independent reviewers. Studies reporting individual outcomes of patients receiving nerve surgery (nerve transfer or nerve graft) for obstetric brachial plexus palsy were included. Non-English language studies were excluded. Patients with non-nerve surgeries that may serve as salvage procedures for upper extremity functionality were excluded. MRC and AMS scores were compared depending on the timing of intervention (3 months, 6 months) for elbow flexion.
RESULTS: There were 170 patients included from 16 studies. There were no significant differences in MRC/AMS scores for elbow flexion when 3 months was used as a cutoff for early intervention (p=0.734, p=0.438, respectively). When 6 months was used as a cutoff for early intervention, there were significantly higher preoperative elbow flexion AMS scores in the late intervention group. After surgery, there were significantly higher elbow flexion MRC scores achieved by the group that received early intervention (6 months) (p=0.014). There were also higher AMS scores achieved on average by the early intervention group, although this difference did not achieve statistical significance (p=0.163).
DISCUSSION AND CONCLUSION: Patients with suspected obstetric brachial plexus injury requiring intervention that undergo nerve grafting or nerve transfer within 6 months of birth seem to have better postoperative elbow flexion outcomes than patients operated upon after 6 months.
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