Traumatic brachial plexus injuries in children, excluding obstetric palsy: Outcome of surgical treatment by nerve grafting and nerve transfer

Traumatic brachial plexus injuries in children, excluding birth palsy, were seldom reported. In this study we report 11 cases operated upon between 1995 and 1998, and followed for at least two years. All patient were males with an average age of 11 years (average 3 to 16 years). The denervation time averaged 3.8 months {range one to eight months). Seven patients had two or more root avulsions, and four patients had avulsion of all roots. A total of nine grafting and 27 extraplexal neurotization procedures were used. Donor nerves included the intercostal nerves, phrenic nerve, spinal accessory nerve, and contralateral C7 root. Elbow flexion was restored in all but two cases. Shoulder abduction varied from 30 to 70 degrees according to the method of reconstruction. Triceps recovered in three cases and finger and wrist extensors in two cases. Wrist and finger flexion was obtained in two cases. Sensory recovery in the palm reached S2/52+. Harvesting the phrenic nerve and the contralateral C7 root resulted in no residual morbidity. Compared to adults, children have higher incidence of root avulsions, same recovery rake of elbow and shoulder functions following plexus reconstruction, but recovery is faster.