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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Current algorithms for obstetric palsy are too aggressive. A practical and conservative approach using triceps and wrist extension assessment

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  • presenting/speaker Michael Solomons - Groote Schuur Hospital, Cape Town, South Africa
  • Aude Bommier - Groote Schuur Hospital, Cape Town, South Africa
  • Duncan McGuire - Groote Schuur Hospital, Cape Town, South Africa
  • Michelle Maree - Groote Schuur Hospital, Cape Town, South Africa

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-262

doi: 10.3205/19ifssh1410, urn:nbn:de:0183-19ifssh14101

Published: February 6, 2020

© 2020 Solomons et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Current algorithms for surgical indications for obstetric brachial plexus injury (OBPI) use recovery of biceps at 3 months or 4 months. We know the plexus is damaged sequentially with downward traction. Therefore C5 and 6 are more affected than C7 which is worse than C8 etc. C7 can be assessed by measuring triceps and wrist extension.

If there is no C7 at 4 months then the chance of C5/6 recovering is slight. Surgery is indicated. If there is good wrist extension and triceps at 4 months then the decision can be delayed to 6 months as some infants will still recover.

This study will compare our algorithm to those in the literature that advise surgery at 3 months if there is no deltoid or biceps recovery.

Methods: All babies referred to our OBPI clinic over a 9 year period were assessed. Those that presented after 3 months were excluded from this study as were those that were complete palsies and those that had good biceps at 3 months.

57 met the inclusion criteria.

Follow up was monthly with assessment of muscle recovery.

We performed a retrospective review comparing the outcome of babies managed by our algorithm (operative and non-operative), to those in the literature that would have received surgery at 3-4 months where there was no recovery of deltoid/biceps.

Results and Conclusions: Our results show that 52.6% of our infants managed to avoid surgery and have a good outcome, that would have been performed at centers using recovery of biceps/ deltoid at 3 months.

31.6% of our infants avoided surgery that would have been performed at centers using 4 months as the surgical trigger.

We believe that current algorithms are too aggressive and present our algorithm where triceps and wrist extension are assessed at 4 months. Those that do not have these functions are booked for surgery. Those that do are observed for a further two months. If partial recovery of biceps is observed then a cookie test is performed at 9 months. If there is no biceps at 6 months or they fail the cookie test at 9 months then surgery is booked