CHILDREN WITH OBSTETRIC BPI

ADULT OBSTETRIC & TRAUMATIC BPI

PATIENTS SEEN ELSEWHERE

Injury Causes

In our clinic, we see 1650-1750 children each year, and among these, perhaps 5 to 10 children each year present with brachial plexus injuries following caesarian section where no significant birth trauma was involved. The presumed mechanism of injury in these children is a positional crush injury during gestation, or an internal mechanical problem such as the presence of an extra rib or other connective tissue which compresses the plexus in utero.

Last year, among our 120 primary surgeries for obstetric brachial palsy, we saw 3 patients with extra ribs or abnormal blood vessels compressing various parts of the plexus, and presenting as brachial plexus injury. However, the vast majority of our children do have one or more classical risk factors in their history. It is highly unusual to see injuries without any significant birth trauma.

The prognosis depends on the severity of injury, and the level of injury. In our experience, many patients who could benefit from surgery are not referred to obstetric brachial plexus specialists in a timely fashion, and have poorer outcomes.

The matter becomes critical because in 12 to 18 months following injury, denervated muscles will not accept a new nerve supply, and remain paralyzed or weak permanently. Because nerves only grow back at one inch per month, time is of the essence in managing these and any other nerve injuries.

A commonly held belief is that 85 to 90% of these injuries recover completely. In our experience of 15 years and over 5000 patients, this is far from accurate, and although the actual number of patients who recover 100% function in a few days or weeks is unknown, it is our firm belief that the presence of any disability at 3 months following birth injury requires evaluation by a surgical specialist.

This does not imply that all of these patients require surgery, but that surgical specialists who deal with obstetric palsy routinely should be involved relatively early so that the time clock of muscle atrophy is managed appropriately. It is also important to include a surgical specialist in your consultation group because many non-surgical physicians are simply unaware of the benefits and new techniques available for nerve reconstruction.

Because the overall spectrum of injury is so diverse, and because
experience dictates specific management for each child, consultation with a
specialist is critical to maximize outcome.

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Last Updated June 29 2006 21:53:48.    Hits: