In preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.

IntroductionThe goal is to assess the usefulness of diagnostic imaging in diagnosing perinatal preganglionic injuries of the brachial plexus.Material and methodsThe clinical material included 40 children of both genders, aged 2 to 35 months. The authors analysed the results of diagnostic imaging examinations (myelography in 20 cases and magnetic resonance [MR] myelography in 20 cases), intraoperative view and clinical course.ResultsIn 13 out of 40 (32.5%) examined children, no evidence of avulsion of the roots of the spinal nerves was found either by diagnostic imaging or during the surgery. In 3 cases (7.5%) with avulsed roots of the spinal nerves, the diagnostic imaging and intraoperative appearance were in agreement. Total agreement of the diagnostic imaging and intraoperative view was found in 40% of cases. In 9 patients (22.5%) suspected avulsion of roots of the spinal nerves was not confirmed during the surgery. However, the further clinical course of the disease in these cases indicated high probability of avulsion of roots without their pull-out from the intervertebral foramens. In the remaining cases, the findings were as follows: false positive results – 7 (17.5%), false negative results – 1 (2.5%), results underestimating injury – 3 (7.5%), results overestimating injury – 2 (5%).ConclusionsIt was determined that the usefulness of pre-operative diagnostic imaging is limited. Due to the risk of occurrence of false positive and false negative results, final decisions concerning selection of the surgical technique must be based on the analysis of the intraoperative view and preoperative clinical symptoms.

1. While surgical repair may be indicated in brachial plexus injuries at all levels, it is usually inevitable in total and upper-middle palsies. 2. The surgical outcome depends on the extent of baseline damage to the brachial plexus, with the best prognosis in insolated upper palsies.

2Kierownik: prof. dr hab. M. Mędraś the aim of the study was the estimation of the results of surgical correction in pronation or supination forearm deformity. material and methods. Clinical material comprised 19 patients, both sexes, in age from 2 years 3 months to 14 years who were treated in years 2001-2007 because of forearm deformation due to perinatal brachial plexus palsy. Evaluation of the results of surgical treatment has been performed in all cases with using Al-Qattan's scale. Results. As a result of performed tenomioplastic operations in all operated patients functional position of forearm has been achieved (grade 3 in Al-Qattan's scale)., and in 8 cases additionally good range of pronation and supination (grade 4 in Al-Qattan's scale). conclusions. The necessity of forearm deformity correction in perinatal brachial plexus palsy may concern patients who have been treated microsurgically in very early childhood, and also patients who haven't been qualified to primary surgical treatment because of significant improvement of upper limb function as a result of rehabilitation. Tenomioplastic operations used in forearm position correction should be reserved for patients without fixed contracture who have possibility of forearm passive rotation moves. These procedures are burdened by low risk of complications and with proper qualification they can provide significant improvement of upper limb functional efficiency.

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