title: Reconstruction of pediatric brachial plexus injuries with nerve grafts and nerve transfers.
abstract: OBJECTIVE
  To review the demographics and injury patterns in consecutive pediatric patients with traumatic brachial plexus injury presenting to a single center over a 16-year period and to review the outcomes of nerve grafting and nerve transfers for reconstruction of shoulder abduction and elbow flexion in these patients.
  
  
  METHODS
  Forty-five pediatric patients presented for treatment of traumatic Brachial plexus injury from 1996 to 2012. Subgroup analysis of patients who had nerve grafting or nerve transfers for restoration of shoulder abduction and elbow flexion was carried out to compare outcomes of Medical Research Council (MRC) motor grading.
  
  
  RESULTS
  The mean age of patients was 13.8 years (range, 3-17 y). Panplexal injuries (62%) and upper plexus injuries (16%) were particularly common. There was a very high proportion of preganglionic injuries (91%). Six of the 10 of patients who underwent intraplexal nerve grafting only for restoration of shoulder abduction achieved grade 3 or better power compared with 42% (5/12) of patients who had nerve transfers. When contralateral C7 was used as a donor for nerve transfer in restoration of shoulder abduction, 1 of the 5 patients achieved grade 3 or better shoulder abduction. All 4 patients who had nerve grafts for restoration of elbow flexion achieved grade 3 or better power, compared with 11 of 12 patients who had nerve transfers. There was no statistical difference in outcome (MRC grade 3 or 4) between patients who had nerve grafts and those who had nerve transfers.
  
  
  CONCLUSIONS
  This study shows that nerve grafts can result in similar outcomes (MRC grading) to nerve transfers for restoration of shoulder abduction and elbow flexion in traumatic pediatric BPI. The findings of this study do not support the use of contralateral C7 as a donor for nerve transfer in reconstruction of shoulder abduction in this age group.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN.
authors.forename: Harvey
authors.initials: H
authors.lastname: Chim
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN.
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Kircher
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN.
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN. Electronic address: shin.alexander@mayo.edu.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Brachial plexus injury; contralateral C7; nerve graft; nerve transfer; pediatric brachial plexus