Obstetrical brachial plexus palsy: Patterns of injuries. Morphologic findings in 27 cases

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Sebastian Valbuena

Abstract

BackgroundTo determine the morphological patterns of obstetrical brachial plexus lesions in 27 cases.Methods The clinical records of 27 microsurgical reconstructions of brachial plexus, performed between 2009 and 2012 were evaluated. Narakas classification was used and the surgical findings were compared with the clinical patterns.ResultsEighteen different types of anatomical lesions were found. The major diversity of injuries was detected in the group of total brachial plexus palsy. However, rupture of the upper root and avulsion of the lower root were the most frequent patterns. The clinical involvement of C7 root did not always correlate with the surgical findings. The obstetrical brachial plexus palsy has a great diversity of anatomical lesions. The microsurgical exploration and reconstruction is difficult, and it demands the knowledge of all different reconstructions due the diversity of the injury patterns. KEY WORDS: Brachial plexus. Obstetrical b

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How to Cite
Valbuena, S. (2013). Obstetrical brachial plexus palsy: Patterns of injuries. Morphologic findings in 27 cases. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 77(4), 233-239. https://doi.org/10.15417/124
Section
Clinical Research
Author Biography

Sebastian Valbuena, Hospital El Cruce. Alta complejidad en red. Dr. Nestor Carlos Kirchner

Sector Miembro Superior y Microcirugia. Servicio de Ortopedia y Traumatologia.

References

1. Adler JB, Patterson RL Jr. Erb’s palsy. Long-term results of treatment in eighty-eight cases. J Bone Joint Surg Am 1967;49:1052-64.

2. Al-Qattan MM, Clarke HM, Curtis CG. Klumpke´s birth palsy. Does it really exist? J Hand Surg Br 1995;20(1):19-23.

3. Narakas AO. Obstetrical brachial plexus injuries. In: Lamb DW (ed.). The Paralysed Hand. Edinburgh: Churchill Livingstone; 1987, p. 116-35.

4. Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 2010;35(2):322-31.

5. Hoeksma AF, Wolf H, Oei SL. Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture. Clin Rehabil 2000;14:523-26.

6. Gilbert A, Khouri N, Carlioz H. Birth palsy of the brachial plexus: surgical exploration and attempted repair in 21 cases. Rev Chir Ortho Reparatrice Appar Mot 1991;66:33-42.

7. Firpo CA, Miranda H, Franzosi N. Secuela de las parálisis obstétricas del hombro. Rev Asoc Argent Ortop Traumatol 2010;75:236-43.

8. Marcus JR, Clarke HM. Management of obstetrical brachial plexus palsy. Evaluation, prognosis, and primary surgical treatment. Clin Plastic Surg 2003;30:289-306.

9. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995;11:583-94.

10. Zancolli EA, Cozzi EP. Nervios de la extremidad superior. II Plexo braquial (topografía funicular en las partes indivisas y aplicaciones
quirúrgicas). In: Zancolli EA, Cozzi EP (eds.). Atlas de Anatomía Quirúrgica de la Mano. Buenos Aires y Madrid: Editorial Médica Panamericana; 1993, p. 652-60.

11. Gilbert A. III Obstetrical paralysis. Indication and strategy. In: Gilbert A (ed.). Brachial Plexus Injuries. London: Martin Dunitz; 2001, p. 205-10.

12. Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent frenic nerve palsy in newborn children with Erb´s palsy. J Hand Surg Br 1998;23:225.

13. Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent Horner´s syndrome in total obstetric brachial plexus injury. J Hand Surg Br 2000;25:166-7.

14. Gilbert A. Obstetrical paralysis. In: Tubiana R, Gilbert A (eds.). Tendon, Nerve and Other Disorders. London and New York: Taylor & Francis; 2005, p. 471-514.

15. Gilbert A, Brockman R, Carlioz H. Surgical treatment of brachial plexus palsy. Clin Orthop Relat Res 1991;264:39-47.

16. Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin 1995;11:563-80; discussion 580-81.

17. Waters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction
in brachial plexus birth palsy. J Bone Joint Surg Am 1999;81:649-59.

18. Zancolli EA, Zancolli ER Jr. Palliative surgical procedures in sequelae of obstetric palsy. Hand Clin 1988;4:643-69.

19. Tse R, Marcus JR, Curtis CG, Dupuis A, Clarke HM. Suprascapular nerve reconstruction in obstetrical brachial plexus palsy: spinal accessory nerve transfer versus C5 root grafting. Plast Reconstr Surg 201;127:2391-6.

20. El-Gammal TA, El-Sayed A, Kotb MM Ragheb YF, Saleh WR, Elnakeeb RM, et al. Total obstetric brachial plexus palsy: results and strategy of microsurgical reconstruction. Microsurgery 2010;30:169-78