Treatment of Obstetrical Brachial Plexus Injuries: Experience in Osaka.

Early surgical intervention in obstetrical brachial plexus palsy started with sophisticated microsurgery techniques about 20 years ago. However, the indication for the operation is still controversial. A new classification of obstetrical brachial plexus palsy is advocated to establish systematic surgical planning. It is based on the mode of delivery and type of paralysis at 1 month old. It consists of four main types: type I, vertex delivery–upper type palsy; type II, vertex delivery–total type palsy, incomplete; type III, vertex delivery–total type palsy, complete; type IV, breech delivery–upper type palsy. Two types are added to cover the whole spectrum of this condition. Type O is neurapraxia and is clinically unimportant. Type V is a miscellaneous type, which should be considered individually. Most of the cases are classified into one of the four main types. The first priority for reconstruction is given to upper root function in types I and IV, posterior cord function in type II, and hand function in type III. The surgical procedure is intraplexal neurotizations in type I, and a combination of intraplexal and extraplexal neurotizations is a choice in types II and III. In type IV, extraplexal neurotizations are necessary. Surgical results are also discussed briefly in this article.