Abstract
Despite the impressive advancements in prenatal planning and assessment, obstetrical brachial plexus palsy remains an unfortunate consequence of difficult childbirth.
Although the majority of infants with plexopathy recover with minor or no residual functional deficits, a number of children do not regain sufficient limb function and develop significant functional limitations, bony deformities and joint contractures.
Recent developments in the technique of microsurgical reconstruction of peripheral nerve injuries proved to be effective in selected cases of children with obstetrical brachial plexus injury.
Many of these children and those who were defined as having minor injury will remain with considerable functional limitation and deserve late orthopaedic reconstruction.
Based on that, we developed a multidisciplinary Brachial Plexus clinic gathering a microsurgeon, a pediatric orthopaedic surgeon, an electrophysiologist clinician, physiotherapists and occupational therapist in order to assess and evaluate these children.
A total of 105 children were seen and followed up in our clinic during the last 2 years.
Most of these children were referred to our clinic from other centers and from physiotherapists treating these children on an out-patient basis.
We report the orthopaedic reconstruction operations performed in 9 cases of residual functional disabilities in children born with obstetric palsy.
4 patients had latissimmus dorsi and teres major transfer.
2 patients had derotation osteotomy of the humerus.
1 patient had Steindler flexorplasty of the elbow.
2 patients had open reduction and capsulorrhapy for a dislocated shoulder.
Video assessment of these children was performed before and after the operation. Function was also analyzed before and after operation by a physiotherapist and an occupational therapist.
Significant functional improvement was achieved, to the satisfaction of patients and parents.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
