Long-Term Hand Function Outcomes of the Surgical Management of Complete Brachial Plexus Birth Injury
| Autor: | Brad T. Morrow, Howard M. Clarke, Emily S. Ho, Isaac Harvey |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Activities of daily living Nerve root 030230 surgery Wrist Thumb Avulsion 03 medical and health sciences 0302 clinical medicine Activities of Daily Living Birth Injuries Medicine Humans Orthopedics and Sports Medicine Brachial Plexus Brachial Plexus Neuropathies Child Nerve Transfer Functional movement Retrospective Studies 030222 orthopedics business.industry Infant medicine.disease Birth injury Surgery body regions medicine.anatomical_structure Child Preschool business Brachial plexus |
| Zdroj: | The Journal of hand surgery. 46(7) |
| ISSN: | 1531-6564 |
| Popis: | Purpose Hand function outcomes of primary nerve reconstruction for total brachial plexus birth injury (BPBI) are confounded by nerve roots left in continuity, inclusion of secondary procedures, and no assessment of the ability to perform activities of daily living. The purpose of this study was to evaluate the long-term hand function outcomes in a cohort of patients with a complete BPBI who had no nerve root in continuity prior to primary nerve reconstruction targeting the lower trunk. Methods This single-center retrospective case series of complete BPBI included patients who underwent primary nerve reconstruction. The outcomes were assessed using the active movement scale (AMS) and brachial plexus outcome measure preoperatively and at the age of 4 and 8 years. Results Fifty patients with a complete BPBI, of whom 82% (41/50) had an avulsion of C8-T1, underwent primary nerve reconstruction at a mean age of 4.1 months. Compared with the preoperative AMS scores, a statistically significant increase of AMS scores was observed at 4 and 8 years of age for all movements except forearm pronation. Between 4 and 8 years of age, there was a statistically significant improvement of external rotation of the shoulder and elbow flexion as well as diminution of thumb flexion. In the brachial plexus outcome measure assessment, there were 83% (24/29) at 4 years and 81% (21/26) at 8 years who had sufficient functional movement to perform wrist, finger, and thumb activities. Conclusions Functional hand outcome was restored to sufficiently perform bimanual activity tasks in 81% (21/26) of patients with a complete BPBI at 8 years of age. This affirmed that primary nerve reconstruction reinnervating the lower trunk can result in a functional extremity. Type of study/level of evidence Therapeutic IV. |
| Databáze: | OpenAIRE |
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