[Indications and results of operative treatment in birth-related brachial plexus injuries].

INTRODUCTION: A review of the literature reveals that under conventional treatment alone or in combination with secondary muscle/tendon transfer about 4 to 43 % of cases show incomplete recovery with severe functional and/or aesthetic impairment. When these patients undergo early microsurgical brachial plexus revision, a regeneration without any significant functional and/or aesthetic impairment can be achieved in 80 to 90 % of the cases. Moreover, microsurgical reconstruction of the brachial plexus does increase the possibilities of secondary muscle/tendon transfers. MATERIALS AND METHODS: Our concept is based on our experience with more than 1700 patients presenting with brachial plexus lesions between 1981 and 2000 who were treated in our institution. Patient selection is done according a standardized algorithm which is presented. There were 418 obstetrical brachial plexus lesions. 189 could be treated conservatively. In 225 cases operative treatment was necessary. 104 cases underwent early revision of the brachial plexus and secondary tendon transfer was done in 121 patients. RESULTS: Personal results and an analysis of the literature reveal that in C5/C6 lesions good shoulder function can be achieved in 60 to 80 %, especially if the accessory nerve is routinely used. Good elbow function can be expected in over 90 %. In C5/C6/C7 lesions, there are only slightly inferior results. In both groups there is a significant functional improvement by secondary tendon transfer at the age of two to three years. In the rare C5 - Th1 lesions, the functional results depend on the number and quality of the remaining roots. CONCLUSIONS: Provided there is good patient selection, severe obstetrical brachial plexus injuries should be scheduled for early microsurgical revision. There is no need to wait for a frustrating spontaneous recovery.