Surgical Management of Traumatic Brachial Plexus Injuries in the Pediatric Population

Objective: To evaluate demographics, treatment options, and outcomes of traumatic brachial plexus injuries in pediatric patients. Methods: Traumatic brachial plexus reconstructions in patients ≤17 years old were reviewed. Patients were stratified into pan-plexus and incomplete plexus injuries. Functional outcomes (modified British Medical Research Council grade) were reviewed after a minimum follow-up of 9 months. Results: Brachial plexus reconstruction was performed in 71 patients at a mean age of 13.9 years (range, 2–17 years). Approximately half of the patients had a pan–brachial plexus injury (n = 33, 46.5%) with 59.2% having at least 1 preganglionic avulsion injury. Among the 25 patients with pan–brachial plexus injuries who had >9 months of follow-up, 12 (48%), 24 (96%), and 17 (68%) had reconstruction surgery for shoulder, elbow, and grasp function, respectively. At last follow-up, 50%, 83%, and 29% of these patients had a modified British Medical Research Council grade ≥3 in shoulder abduction, elbow flexion, and grasp, respectively. Of the 31 patients with incomplete brachial plexus injuries, 28 (90%) underwent reconstruction for shoulder function, and 13 (42%) underwent surgery for elbow flexion. At last follow-up, 71% and 100% of patients had modified British Medical Research Council grade 3 in shoulder abduction and elbow flexion, respectively. Conclusions: Pediatric traumatic brachial plexus injuries are often high-energy injuries resulting in nerve root avulsions. Most patients were able to regain antigravity elbow flexion or stronger after brachial plexus reconstruction, and more than half had similar improvement in shoulder function. Treatment should be directed with goals of elbow flexion, shoulder stability/external rotation, and rudimentary grasp.