Surgical treatment of brachial plexus traction injuries in children, excluding obstetric palsy. 2003

Tarek Abdalla El-Gammal, and Amr El-Sayed, and Mohammed M Kotb
Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt.

Traumatic brachial plexus injuries in children, excluding birth palsy, are seldom reported. In this study, we report on 11 cases operated upon between 1995-1998, and followed for at least 30 months. All patients were males with an average age of 11 years (range, 3-16 years). The denervation time averaged 3.8 months (range, 1-8 months). Eight patients had two or more root avulsions; two had additional severe infraclavicular injuries. In total, 6 grafting and 25 extraplexal neurotization procedures were used. Donor nerves included the intercostal nerves, phrenic nerve, spinal accessory nerve, and contralateral C7 root. Elbow flexion was restored in all but 2 cases. Shoulder abduction varied from 30-90 degrees, according to the method of reconstruction. Triceps recovered in 2 cases and finger and wrist extensors in 1 case. Wrist and finger flexion was obtained in 1 case. Sensory recovery in the palm reached S2/S2+. Harvesting the phrenic nerve and the contralateral C7 root resulted in no residual morbidity. Compared to adults, children have a higher incidence of root avulsion, no deafferentiation pain, a higher incidence of associated skeletal injuries, and the same recovery rate of elbow and shoulder functions following plexus reconstruction, but recovery is faster. Given the frequency of root avulsions, neurotization is often required.

UI MeSH Term Description Entries
D008297 Male Males
D008866 Microsurgery The performance of surgical procedures with the aid of a microscope.
D009416 Nerve Regeneration Renewal or physiological repair of damaged nerve tissue. Nerve Tissue Regeneration,Nervous Tissue Regeneration,Neural Tissue Regeneration,Nerve Tissue Regenerations,Nervous Tissue Regenerations,Neural Tissue Regenerations,Regeneration, Nerve,Regeneration, Nerve Tissue,Regeneration, Nervous Tissue,Regeneration, Neural Tissue,Tissue Regeneration, Nerve,Tissue Regeneration, Nervous,Tissue Regeneration, Neural
D010246 Paralysis, Obstetric Paralysis of an infant resulting from injury received at birth. (From Dorland, 27th ed) Paralysis, Obstetrical,Obstetric Paralyses,Obstetric Paralysis,Obstetrical Paralyses,Obstetrical Paralysis,Paralyses, Obstetric,Paralyses, Obstetrical
D001917 Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. Plexus, Brachial
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths

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