Evaluation of surgical outcomes of obstetric brachial plexus birth injury: clinical and electrophysiological study
Diaa F Mohasseb1, Marwa M Hassan MD 1, Ahmed E Semaya2, Hayam M Abdelghany3, Sarah N Hassan4
1 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
2 Department of Orthopedic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
3 Department of Physical Medicine, Rheumatology and Rehabilitation, Alexandria University Hospitals, Alexandria, Egypt
4 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Helwan University, Helwan, Egypt
Marwa M Hassan
Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, 21111
Source of Support: None, Conflict of Interest: None
Background Obstetric brachial plexus birth injury (OBPBI) is a relatively common form of birth injury that might lead to a weighty physical disability. Early microsurgical intervention for properly selected patients will result in maximal functional benefit that couldn’t be otherwise obtained. However, the outcomes of different microsurgical techniques need to be further evaluated and compared.
Aim To evaluate the outcomes of different microsurgical techniques performed in patients with OBPBI.
Patients & Methods Twenty-eight patients with OBPBI meeting the criteria for surgical intervention were included in the study. Preoperative and one year postoperative clinical and electrophysiological assessments were done.
Results Thirteen (46.4%) of the studied patients were males and 15 (53.6%) were females. The mean age of patients in the study was 8.64 months ± 4.40; ranging between (3.0 – 16.0 months),7 patients had Horner syndrome.C5 and C6+/-C7 roots affection was the most frequent lesion ,patients who underwent neurotization recovered earlier than patients who underwent nerve grafting ,on the other hand nerve grafting resulted in more significant postoperative improvement after a 12 months follow up period.
Conclusions The current study provided additional evidence that the earlier the surgical intervention in OBPBI, the better the outcomes.Neurotization results in earlier functional recovery in patients with OBPBI than nerve grafting reconstructive techniques. On the other hand, nerve grafting was superior to neurotization regarding the degree of improvement. Postoperative electrophysiological follow-up can be done using the CMAP amplitude and AUC percentages reflecting the percentage of viable axons.