Surgical strategy for infant obstetrical brachial plexus palsy: Experiences at Chang Gung Memorial Hospital

Background: Strategies for management of infant obstetrical brachial plexus palsy remain controversial, including timing of surgery and treatment modalities. Methods: The senior author (Chuang) performed surgical explorations on 78 infant obstetrical brachial plexus palsy patients from 1992 to 1999. Sixty-eight patients underwent brachial plexus operation during the infant period (2 to 11 months), and 10 patients underwent surgery beyond the infant period. Results: For the ruptured upper and/or middle trunk injury (Erb's palsy), better shoulder and elbow function was observed in those who received numerous short grafts from C5 to the suprascapular and posterior division and from the C6 spinal nerve to the anterior division of the upper trunk. For the rupture injury associated with root avulsion (total palsy), nerve graft and transfer (intraplexus and extraplexus) provided a one-stage reconstruction for shoulder, elbow, and especially hand functions. The contralateral C7 or ipsilateral part of the ulnar nerve transfer was rarely used in infant obstetrical brachial plexus palsy, compared with adult brachial plexus injury. Conclusions: The operative results proved that earlier timing of nerve surgery (within 3 months) is strongly indicated in patients who have total palsy, and only relatively indicated in patients with isolated rupture of the upper plexus.