title: Obstetric brachial plexus palsy: reviewing the literature comparing the results of primary versus secondary surgery.
abstract: Obstetric brachial plexus injuries (OBPP) are a relatively common stretch injury of the brachial plexus that occurs during delivery. Roughly 30 % of patients will not recover completely and will need a surgical repair. Two main treatment strategies have been used: primary surgery, consisting in exploring and reconstructing the affected portions of the brachial plexus within the first few months of the patient's life, and secondary procedures that include tendon or muscle transfers, osteotomies, and other orthopedic techniques. Secondary procedures can be done as the only surgical treatment of OBPP or after primary surgery, in order to minimize any residual deficits. Two things are crucial to achieving a good outcome: (1) the appropriate selection of patients, to separate those who will spontaneously recover from those who will recover only partially or not at all; and (2) a good surgical technique. The objective of the present review is to assess the published literature concerning certain controversial issues in OBPP, especially in terms of the true current state of primary and secondary procedures, their results, and the respective roles each plays in modern-day treatment of this complex pathology. Considerable published evidence compiled over decades of surgical experience favors primary nerve surgery as the initial therapeutic step in patients who do not recover spontaneously, followed by secondary surgeries for further functional improvement. As described in this review, the results of such treatment can greatly ameliorate function in affected limbs. For best results, multi-disciplinary teams should treat these patients.
authors.affiliation: Department of Neurosurgery, Peripheral Nerve & Brachial Plexus Unit, University of Buenos Aires School of Medicine, La Pampa 1175 5 A, 1428, Buenos Aires, Argentina. marianosocolovsky@gmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Socolovsky
authors.affiliation: Department of Neurosurgery, Hospital de León, León, Spain.
authors.forename: Javier Robla
authors.initials: JR
authors.lastname: Costales
authors.affiliation: Department of Neurosurgery, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Miguel Domínguez
authors.initials: MD
authors.lastname: Paez
authors.affiliation: Department of Orthopedic Surgery, Peripheral Nerve & Brachial Plexus Unit, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Nizzo
authors.affiliation: Department of Orthopedic Surgery, Hospital de Alta Complejidad en Red El Cruce, Buenos Aires, Argentina.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Valbuena
authors.affiliation: Department of Orthopedic Surgery, Hospital Ricardo Gutierrez, Buenos Aires, Argentina.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Varone
mesh_terms: D001720:Birth Injuries / Q000209:etiology* / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries; D020516:Brachial Plexus Neuropathies / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019635:Neurosurgical Procedures / Q000379:methods*
keywords: Graft repair; Nerve transfers; Obstetric brachial plexus palsy; Primary surgery; Secondary surgery