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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 5, 649-654.
doi: 10.1302/0301-620X.91B5.21878  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Nerve reconstruction in patients with obstetric brachial plexus injury results in worsening of glenohumeral deformity

A CASE-CONTROL STUDY OF 75 PATIENTS

R. K. Nath, MD, Plastic and Reconstructive Surgeon1; and X. Liu, PhD, Research Scientist1

1 Texas Nerve and Paralysis Institute, 6400 Fannin Street, Suite 2420, Houston, Texas 77030, USA.

Correspondence should be sent to Dr R. K. Nath; e-mail: drnath{at}drnathmedical.com

Whereas a general trend in the management of obstetric brachial plexus injuries has been nerve reconstruction in patients without spontaneous recovery of biceps function by three to six months of age, many recent studies suggest this may be unnecessary. In this study, the severity of glenohumeral dysplasia and shoulder function and strength in two groups of matched patients with a C5-6 lesion at a mean age of seven years (2.7 to 13.3) were investigated. One group (23 patients) underwent nerve reconstruction and secondary operations, and the other (52 patients) underwent only secondary operations for similar initial clinical presentations. In the patients with nerve reconstruction shoulder function did not improve and they developed more severe shoulder deformities (posterior subluxation, glenoid version and scapular elevation) and required a mean of 2.4 times as many operations as patients without nerve reconstruction.

This study suggests that less invasive management, addressing the muscle and bone complications, is a more effective approach. Nerve reconstruction should be reserved for those less common cases where the C5 and C6 nerve roots will not recover.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General