Traumatic brachial plexus injury in the pediatric population

Traumatic brachial plexus injuries Trauma Brachial plexus injury in children are very rare. A particular characteristic of pediatric patients is a high incidence of root avulsions. Compared to adults, children also have minimal deafferentation pain and a higher incidence of associated skeletal injuries and exhibit faster recovery. The approach to children with traumatic brachial plexus injuries can be divided into three groups based on age. In very young children (<4 years of age), management is focused on restoring and maximizing hand function, similar to patients with obstetric brachial plexus injuries. In children more than 12 years of age, management is similar to that in adult patients. For these patients, the priorities for restoring function, in order of importance, are elbow flexion, shoulder abduction and/or stability, hand sensation, wrist extension and finger flexion, wrist flexion and finger extension, and lastly, intrinsic hand function. This approach relies on maximizing function while prioritizing movements that have the least distance for nerves to regenerate to target muscles. For children in between 4 and 12 years of age, treatment priorities are controversial. In this chapter, the approach to and workup of children with traumatic brachial plexus injuries is described, as well as treatment options such as nerve grafts, nerve transfers, and free functioning muscle transfers.