J Reconstr Microsurg 2014; 30 - A007
DOI: 10.1055/s-0034-1373909

Unusual Presentation of Obstetric Brachial Plexus Palsy

Hassan H. Noaman 1
  • 1Hand and Reconstructive and Microsurgical Unit, Sohag University, Sohag, Egypt

Introduction: Obstetric brachial plexus injury is challenging subject. Great debate is raising as regard the indication for surgical treatment, time of surgery, methods of reconstruction. Upper type is more common than total and other described types. Vaginal, cephalic leads to shoulder dystocia is the most common type of presentation. We describe the unusual types of presentation.

Methodology and Material: Between March 2000 and March 2012, 300 cases had been reviewed in hand and microsurgical unit, Orthopedic Dept, Sohag University. Right side was affected in 180 (60%) cases; male was affected more than female (65-35%). The average body weight was 4 Kg (3-4.9 kg). First baby was involved in 60%, 2nd baby in 32, 3rd, 4th, 5th, and 6th in 8%. Upper type constituted 85%, while total type performed 18% (54 cases).

Unusual presentation:

  • Newborn delivered by caesarean section 4/300 (1/75).

  • Breech presentation 2/300.

  • Late presentation 20/300.

  • Bilateral 2/300.

  • OBPP associated with CP 1/300.

    • Sixty patients (20%) underwent brachial plexus reconstruction.

    • Forty five (15%) had total OBPP.

    • Fifteen patients (5%) had upper type.

    • The average time of surgery for upper type was 5 month (ranged 3-7 month).

    • The average time of surgery for the total type was 4 month (ranged 3-6 month).

Results: - The average follow up was 86 month (ranged from 12-120 month).

- We used Gilbert- Raimondi scale for postoperative evaluation of the results. Average shoulder movement (abduction) was 110 degrees, elbow flexion was more than 120 degrees from zero, and elbow extension was full in 37 patients (82%) among 45 patients of upper type OBPP. In total type (15 patients), the average gain of shoulder abduction was 90 degrees, elbow flexion up to 100 degrees, wrist and fingers flexion G4, wrist and fingers extension G3 in 11 patients (73%). We recommend doing brachial plexus exploration and reconstruction from 3-4 month of age in the total type, and 4-5 month of age in the upper type.

Conclusions: We present the unusual type of obstetric brachial palsy that have not been described in the literature and their treatment strategy.