The outcome of primary brachial plexus reconstruction in extended Erb’s obstetric palsy when only one root is available for intraplexus neurotization

BACKGROUND: A recent review by the International Federation of Societies for Surgery of the Hand showed no studies comparing the results of nerve grafting to distal nerve transfer for primary reconstruction of the brachial plexus in infants with obstetric brachial plexus palsy (OBBP). The aim of this retrospective study is to compare two surgical reconstructive strategies in primary reconstruction of the brachial plexus in extended Erb’s obstetric palsy with double root avulsion: one with and one without distal nerve transfer for elbow flexion. METHODS: Two groups of infants with extended Erb’s palsy and double root avulsion were included in the study. Group I (n = 29) underwent reconstruction of the brachial plexus without distal nerve transfer. In group II (n = 26), the reconstruction included a distal nerve transfer for elbow flexion. RESULTS: Both groups had an excellent (over 96%) satisfactory outcome for elbow flexion. Group II has a significantly better outcome (P < 0.05) of shoulder abduction and wrist extension than group I. CONCLUSIONS: The use of a distant nerve transfer for bicep reconstruction in extended Erb’s obstetric palsy with double root avulsion gives a better outcome for shoulder abduction and wrist extension; and this seems to be related to the availability of more cable grafts to reconstruct the posterior division of the upper trunk and the middle trunk. Level of Evidence: Level III, therapeutic study