Orthopaedic sequelae in neurologically recovered obstetrical brachial plexus injury. Case study and literature review

Steeg, Anne Marie Ter; Hoeksma, A. F.; Dijkstra, P. F.; Nelissen, Rob G H H; Jong, B. A. De

doi:10.1080/713813428

Cited by 6 publications

(8 citation statements)

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“…Although this final sub-division can only be made in retrospect, the distinction between children with and without need for intensive treatment can now be made in good time. The importance of this was confirmed by the results of our previous studies, in which children with delayed complete neurological recovery were found to have a high incidence of shoulder contracture and bony deformity ter Steeg et al 2003).…”

Section: Discussionmentioning

confidence: 60%

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Hoeksma

Steeg

Nelissen

et al. 2004

Develop Med Child Neuro

183

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An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good.

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Section: Discussionmentioning

confidence: 60%

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Hoeksma

Steeg

Nelissen

et al. 2004

Develop Med Child Neuro

183

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“…4 Three months was selected as "satisfactory" referral timing. While evidence is not sufficient to support specific nonoperative physical therapy protocols with referral at 1 month, 10,18,63 there is growing evidence to support operative nerve repair beginning at 3 months of age. 19 Canadian OBPI surgeons indicate preference for early referral 4,7,12 to allow for serial assessment by a multidisciplinary team, with indications for nerve repair beginning at 3 months.…”

Section: Referral Processesmentioning

confidence: 99%

Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

Coroneos¹,

Voineskos²,

Coroneos

et al. 2016

PED

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OBJECT The aim of this study was to determine the volume and timing of referrals for obstetrical brachial plexus injury (OBPI) to multidisciplinary centers in a national demographic sample. Secondarily, we aimed to measure the incidence and risk factors for OBPI in the sample. The burden of OBPI has not been investigated in a publicly funded system, and the timing and volume of referrals to multidisciplinary centers are unknown. The incidence and risk factors for OBPI have not been established in Canada. METHODS This is a retrospective cohort study. The authors used a demographic sample of all infants born in Canada, capturing all children born in a publicly funded, universal healthcare system. OBPI diagnoses and corresponding risk factors from 2004 to 2012 were identified and correlated with referrals to Canada’s 10 multidisciplinary OBPI centers. Quality indicators were approved by the Canadian OBPI Working Group’s guideline consensus group. The primary outcome was the timing of initial assessment at a multidisciplinary center, “good” if assessed by the time the patient was 1 month of age, “satisfactory” if by 3 months of age, and “poor” if thereafter. Joinpoint regression analysis was used to determine the OBPI incidence over the study period. Odds ratios were calculated to determine the strength of association for risk factors. RESULTS OBPI incidence was 1.24 per 1000 live births, and was consistent from 2004 to 2012. Potential biases underestimate the level of injury identification. The factors associated with a very strong risk for OBPI were humerus fracture, shoulder dystocia, and clavicle fracture. The majority (55%–60%) of OBPI patients identified at birth were not referred. Among those who were referred, the timing of assessment was “good” in 28%, “satisfactory” in 66%, and “poor” in 34%. CONCLUSIONS Shoulder dystocia was the strongest modifiable risk factor for OBPI. Most children with OBPI were not referred to multidisciplinary care. Of those who were referred, 72% were assessed later than the target quality indicator of 1 month that was established by the national guideline consensus group. A referral gap has been identified using quality indicators at clinically relevant time points; this gap should be addressed with the use of knowledge tools (e.g., a clinical practice guideline) to target variations in referral rates and clinical practice. Interventions should guide the referral process.

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“…Chan (2002) describes splinting as one of the most useful modalities to minimize deformities, prevent joint contractures, and substitute loss of motor control following a peripheral nerve injury [5]. Ter Steeg et al (2003) reported that shoulder bracing for BRBPI was recommended in the first half of the twentieth century, but then advised against it, and subsequently is seldom mentioned in the modern literature [24]. Existing literature does not clarify why there was a reversal of recommendations, but these papers retrospectively comment that splinting may have led to difficult contractures in the externally rotated and abducted position.…”

Section: Differential Forearm and Humeral Rotation With Elbowmentioning

confidence: 99%

“…In children with otherwise “good” BRBPI recovery, there are very commonly impairments in the passive and active range of both supination (Sup) and shoulder external rotation (ER) [12, 13, 16, 24]. Theories of why this occurs include the following: imbalance of strength in muscles with recovering compared to non-injured nerves, relative agnosia affecting development during recovery of joint sensation and movements, direct shoulder capsular injury during birth, and imbalanced functional reinnervation of some muscles.…”

Section: Introductionmentioning

confidence: 99%

An Early Shoulder Repositioning Program in Birth-Related Brachial Plexus Injury: A Pilot Study of the Sup-ER Protocol

Verchere

Durlacher

Bellows

et al. 2014

Hand (New York, N,Y.)

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Background Birth-related brachial plexus injury (BRBPI) occurs in 1.2/1,000 births in British Columbia. Even in children with "good" recovery, external rotation (ER) and supination (Sup) are often weaker, and permanent skeletal imbalance ensues. A preventive early infant shoulder passive repositioning program was created using primarily a novel custom splint holding the affected arm in full ER and Sup: the Sup-ER splint. The details of the splint and the shoulder repositioning program evolved with experience over several years. This study reviews the first 4 years. Methods A retrospective review of BCCH patients managed with the Sup-ER protocol from 2008 to 2011 compared their recovery scores to matched historical controls selected from our database by two independent reviewers. Results The protocol was initiated in 18 children during the study period. Six were excluded due to the following: insufficient data points, non-compliance, late splint initiation, and loss to follow-up. Of the 12 matches, the Sup-ER group final score at 2 years was better than controls by 1.18 active movement scale (AMS) points (p=0.036) in Sup and 0.96 AMS points in ER (but not statistically significant (p=0.13)). Unexpectedly, but importantly, during the study period, zero subjects were assessed to have the active functional criteria to indicate brachial plexus reconstruction, where previously we operated on 13 %. Conclusions Early application of passive shoulder repositioning into Sup and ER may improve outcomes in function of the arm in infants with BRBPI. A North American multisite randomized control trial has been approved and has started recruitment.

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Orthopaedic sequelae in neurologically recovered obstetrical brachial plexus injury. Case study and literature review

Abstract: There is no consensus on the cause of contractures and bony deformities in children with OBPI. Conservative methods of treatment have changed over the years, without research on the outcome of these treatment changes.

Cited by 6 publications

References 0 publications

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

An Early Shoulder Repositioning Program in Birth-Related Brachial Plexus Injury: A Pilot Study of the Sup-ER Protocol

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