Introduction and Aims: An important prognostic factor in neonatal brachial plexus injury is the timing of biceps recovery. Although the natural history is not clear, biceps recovery after three months has been used to predict universally poor long-term shoulder function. The absence of biceps function at three months has been adopted as an indication for early microsurgery, in an attempt to improve upper limb function. e

Method: Between 1980 and 1992, 170 patients with neonatal brachial plexus injury were entered into a prospective study, which recorded details of the birth and serial examinations. Patients were grouped according to the level of injury and timing of biceps return. Twenty-nine patients were observed to have absent biceps at three months. Twenty-eight of 29 patients were available for long-term review at an average of 11 years and one month (range 5yrs 7mths–16 years). At follow-up, patients answered a questionnaire, underwent muscle strength testing, sensory evaluation, and had their shoulder function graded according to Gilbert’s modification of the Mallet score. The level of injury and time of biceps return were compared to the final outcomes.

Results: The level of injury was C5/6 in 13/28 (46%), C5/6/7 in 5/28 (18%) and pan-plexus in 10/28 (36%), with a Horner’s syndrome in four patients. Of the 28 patients with absent biceps function at three months, biceps contraction was observed in 20 patients (71%) by six months. 13/13 C-5,6 patients, 3/5 C-5,6,7 patients, and 4/9 pan-plexus patients (0/4 of those with a Horner’s syndrome) regained biceps by six months. Twenty-two patients did not have plexus surgery, nine of these had subsequent shoulder surgery. At follow-up, 27 of 28 patients had at least anti-gravity biceps function. Patients who regained biceps function between three and six month had better scores for abduction (p=0.04), hand to neck (p=0.05) and hand to back (p< 0.001) than patients who regained biceps after six months. Patients with C-5, 6 lesions had better scores for external rotation (p=0.04), hand to neck (p=0.05), hand to mouth (p< 0.01) and hand to back (p< 0.001) than patients with pan-plexus lesions. Twelve of the 22 (55%) patients who did not have plexus surgery had Mallet class IV shoulders (good function). Of the C-5, 6 patients who did not have plexus surgery, 8/12 had class IV shoulders.

Conclusion: This study supports the associations between prolonged neurological recovery, more extensive level of injury and worse long-term shoulder function. In patients with C-5, 6 injuries and absent biceps function at three months, good shoulder function is common in the long-term without plexus surgery. This finding is important in considering the indications for and the results of early microsurgical intervention.

Purpose: Hand localisations predominate in Ollier disease. There have however been few studies devoted to this topic and the one report available only presented a few cases. Treatment of multiple enchondromatosis is sometimes discussed with the treatment of solitary enchondromas despite different recurrence behaviour and aggressiveness. A specific approach is indicated.

Material and methods: We present a retrospective series of 22 children treated for multiple enchondromatosis of the hand. One hand was involved in 11 and both hands in 11. We thus identified 246 enchondromas on 33 hands. One girl with Maffucci syndrome died at the age of six years due to angiosarcomatous degeneration of the leg.

Results: At diagnosis, mean age was six years nine months. Pain and pathological fractures were exceptional, observed in three patients. Overall hand function remained satisfactory. We performed surgery for 14 patients (mean age 8 yr 8 mo) due to increasing symptoms and tumour volume. Five patients required two operations and one a third. We thus performed 18 interventions on 37 hand bones (51 surgical procedures). Simple curettage was performed in 21 cases, combined with autologous cancellous grafting in 30 others. One finger had to be amputated due to aggressive recurrence. Radio-lucent residual lesions were found in 62% of the children at mean 19 months follow-up.

Discussion: Hand function remained satisfactory despite a worrisome radiographic aspect. The decision for surgery was basically made to improve the aesthetic aspect of the hand. Many surgical techniques have been proposed. In our experience, it is difficult to eradicate a treated lesion but grafting appears to be more effective than simple curettage.

Conclusion: Function remains good during growth, fractures are exceptional. Lesions stabilise at the end of growth. We have not observed any case of chondrosarcomatous degeneration in our series of paediatric patients. There is however a risk of malignant degeneration which should be suspected in the event of pain, increased tumour volume or pathological fracture.