title: Distal transfers as a primary treatment in obstetric brachial plexus palsy: a series of 20 cases.
abstract: The purpose of this study was to examine the results of spinal accessory nerve to suprascapular nerve (with or without axillary nerve neurotization) and an Oberlin transfer as primary treatment in children with Narakas type I obstetric brachial plexus injuries, when parents refused to consent to conventional nerve trunk-/root-level reconstruction. A total of 20 children with poor shoulder abduction and no biceps antigravity function but with good hand function were treated with spinal accessory nerve to suprascapular nerve and an Oberlin transfer at a mean age of 5.8 months (SD 3.27; range 3-12.) All the patients were evaluated at a mean of 2.8 years (SD 0.8; range 1.5 to 3.8) post-operatively. Three patients were lost to follow-up. Of the remainder, 11 had grade 4+ power of elbow flexion and six patients had grade 4 power at 1 year follow-up; all had 4+ power of elbow flexion at final follow-up. At final follow-up the Mallet score was a mean of 15; (SD 4.22, range 9 to 20). Primary distal nerve transfers can give good outcomes in patients with obstetric brachial plexus injuries and may be an alternative to surgery on the nerve trunks
  
  
  METHODS
  IV.
authors.affiliation: Department of Plastic and Hand Surgery, Institution- Bai Jerbai Waida Hospital for Children, Mumbai, India.
authors.forename: B A
authors.initials: BA
authors.lastname: Ghanghurde
authors.affiliation: Department of Orthopaedic Surgery, Institution- Bai Jerbai Waida Hospital for Children, Mumbai, India.
authors.forename: R
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Department of Plastic and Hand Surgery, Institution- Bai Jerbai Waida Hospital for Children, Mumbai, India.
authors.forename: K M
authors.initials: KM
authors.lastname: Ladkat
authors.affiliation: Department of Plastic and Hand Surgery, Institution- Bai Jerbai Waida Hospital for Children, Mumbai, India.
authors.forename: B B
authors.initials: BB
authors.lastname: Raut
authors.affiliation: Department of Plastic and Hand Surgery, Institution- Bai Jerbai Waida Hospital for Children, Mumbai, India mthatte@gmail.com.
authors.forename: M R
authors.initials: MR
authors.lastname: Thatte
mesh_terms: D001720:Birth Injuries / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016067:Nerve Transfer; D016896:Treatment Outcome
keywords: Obstetric brachial plexus palsy; primary surgery; spinal accessory nerve to suprascapular nerve and Oberlin’s transfer