title: Long-term results of surgery for brachial plexus birth palsy.
abstract: BACKGROUND
  The long-term results of surgical treatment of brachial plexus birth palsy have not been reported. We present the findings of a nationwide study, with a minimum five-year follow-up, of the outcomes of surgery for brachial plexus birth palsy in Finland.
  
  
  METHODS
  Of 1,717,057 newborns, 1706 with brachial plexus birth palsy requiring hospital treatment were registered in Finland between 1971 and 1997. Of these patients, 124 (7.3%) underwent surgery on the brachial plexus at a mean age of 2.8 months (range, 0.4 to 13.2 months). The most commonly performed surgical procedure was direct neurorrhaphy after neuroma resection. One hundred and twelve patients (90%) returned for a clinical and radiographic follow-up examination after a mean of 13.3 years. Activities of daily living were recorded on a questionnaire, and the affected limb was assessed with use of joint-specific functional measures.
  
  
  RESULTS
  Two-thirds (63%) of the patients were satisfied with the functional outcome, although one-third of all patients needed help in activities of daily living. One-third of the patients, including all nine with a clavicular nonunion from the surgical approach, experienced pain in the affected limb. All except four patients used the hand of the unaffected limb as the dominant hand. Shoulder function was moderate, with a mean Mallet score of 3.0. Both elbow and hand function were good, with a mean score on the Gilbert elbow scale of 3 and a mean Raimondi hand score of 4. Incongruence of the glenohumeral joint was noted in sixteen (16%) of the ninety-nine patients in whom it was assessed, and incongruence of the radiohumeral joint was noted in twenty-one (21%). The extent of the brachial plexus injury was found to be strongly associated with the final shoulder, elbow, and hand function in a multivariate analysis.
  
  
  CONCLUSIONS
  Following surgical treatment of brachial plexus birth palsy, substantial numbers of the patients continued to need help performing activities of daily living and had pain in the affected limb, with the pain due to a clavicular nonunion in one-fourth of the patients. The strongest prognostic factor predicting outcome appears to be the extent of the primary plexus injury.
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital for Children and Adolescents, Helsinki University Central Hospital, PL 266, 0029 HUS, Finland. mikko.kirjavainen@hus.fi
authors.forename: Mikko
authors.initials: M
authors.lastname: Kirjavainen
authors.forename: Ville
authors.initials: V
authors.lastname: Remes
authors.forename: Jari
authors.initials: J
authors.lastname: Peltonen
authors.forename: Pentti
authors.initials: P
authors.lastname: Kinnunen
authors.forename: Tiina
authors.initials: T
authors.lastname: Pöyhiä
authors.forename: Timo
authors.initials: T
authors.lastname: Telaranta
authors.forename: Markku
authors.initials: M
authors.lastname: Alanen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Helenius
authors.forename: Yrjänä
authors.initials: Y
authors.lastname: Nietosvaara
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D004551:Elbow Joint / Q000503:physiopathology*; D005387:Finland; D005500:Follow-Up Studies; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology*; D016896:Treatment Outcome