[Surveying limb shortening in obstetrical brachial plexus palsy]

Prior investigators have demonstrated the effectiveness of brachial plexus reconstructive surgery in neonates with obstetrical brachial plexus palsy. In the present study, we compared limb growth in a group of neonates underwent surgery with those who were subjected for surgery but refused. Totally, 55 neonates received treatment during a 10-year period were selected. They were assigned in 2 groups: 25 who could not achieve biceps flexion during the first 3 months and underwent reconstructive surgery [case group], and 30 neonates who had been subjected for reconstructive surgery but refused [control]. Finally, the intact and the injured limb were measured from acromion to the third finger. C5, C6, and C7 were the most common affected sites, while, nerve graft was the most common microscopic surgical approach. Limb shortening was 0-3 cm in operated as compared to 3-25 cm in nonoperated neonates [p<0.05]. Neonates who could not achieve biceps flexion during the first 3 months should be scheduled for reconstructive surgery, mainly with nerve grafting

Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus

Avulsion injury of the brachial plexus is a disease of middle-aged population and is associated with psychological and economical problems. The present study demonstrates our 10-year experience with spinal accessory neurotization for restoration of elbow flexion in affected subjects in Tehran. During this clinical trial, 32 patients undertook spino-bicipital procedure, of whom 14 were treated with fascia lata to transmit biceps force to 2[nd]-5[th] flexors. Three years later patients were reevaluated for flexor performance.Medical Research Council [MRC] grading for these patients were as follow; MRC4: 21 patients [67%], MRC3: 8[25%], MRC2: 2[6%] and MRC1: in one patient [3%]. Of 14 MRC4-patients who were treated with fascia lata, 9 [64%] could carry a 9kg weight and 5 [36%] could carry a 4kg weight. Elbow flexion of 90? and wrist flexion of 25-30 were seen in all patients.Spinal accessory neurotization can be safely employed for restoration of elbow flexion in avulsion injuries of the brachial plexus