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01-11-2013 | Case Report

Oberlin transfer and partial radial to axillary nerve neurotization to repair an explosive traumatic injury to the Brachial Plexus in a child: Case report

Authors: Joseph H. Miller, Sarah T. Garber, Don E. McCormick, Ramin Eskandari, Marion L. Walker, Elias Rizk, R. Shane Tubbs, John C. Wellons

Published in: Child's Nervous System | Issue 11/2013

Abstract

Purpose

Explosive injuries to the pediatric brachial plexus are exceedingly rare and as such are poorly characterized in the medical literature.

Methods

Herein, we describe an 8-year-old who was struck in the neck by a piece of shrapnel and suffered multiple vascular injuries in addition to a suspected avulsion of the cervical 5 and 6 ventral rami. The patient had a complete upper brachial plexus palsy and failed to demonstrate any clinical improvement at 6-months follow-up. He was taken to the operating from for a partial ulnar to musculocutaneous nerve neurotization as well as a partial radial to axillary nerve neurotization.

Results

The patient’s motor exam improved from a Medical Research Council scale 1 to 4+ for biceps brachii and 0 to 4 deltoid function with greater than 90° of shoulder abduction.

Conclusions

This outcome supports complex neurotization techniques as viable treatment options for persistent motor deficits following an upper brachial plexus injury in older, non-infant age, children.

Hou Z, Xu Z (2002) Nerve transfer for treatment of brachial plexus injury: comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves. Chin J Traumatol 5:263–266PubMed

Vargas MI, Viallon M, Nguyen D et al (2010) New approaches in imaging of the brachial plexus. Eur J Radiol 74:403–410. doi:10.1016/j.ejrad.2010.01.024 PubMedCrossRef

Midha R (1997) Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery 40:1182–1188, discussion 1188–1189PubMedCrossRef

Oberlin C, Béal D, Leechavengvongs S et al (1994) Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am 19:232–237. doi:10.1016/0363-5023(94)90011-6 PubMedCrossRef

Orebaugh SL, Williams BA (2009) Brachial plexus anatomy: normal and variant. ScientificWorldJournal 9:300–312. doi:10.1100/tsw.2009.39 PubMedCrossRef

Leechavengvongs S, Witoonchart K, Uerpairojkit C et al (1998) Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases. J Hand Surg Am 23:711–716. doi:10.1016/S0363-5023(98)80059-2 PubMedCrossRef

Loy S, Bhatia A, Asfazadourian H, Oberlin C (1997) Ulnar nerve fascicle transfer onto to the biceps muscle nerve in C5-C6 or C5-C6-C7 avulsions of the brachial plexus. Eighteen cases. Ann Chir Main Memb Super 16:275–284PubMedCrossRef

Haninec P, Kaiser R (2012) Axillary nerve repair by fascicle transfer from the ulnar or median nerve in upper brachial plexus palsy. J Neurosurg. doi:10.3171/2012.5.JNS111572 PubMed

Al-Qattan MM (2002) Oberlin’s ulnar nerve transfer to the biceps nerve in Erb’s birth palsy. Plast Reconstr Surg 109:405–407PubMedCrossRef

10.

Bertelli JA, Kechele PR, Santos MA et al (2007) Axillary nerve repair by triceps motor branch transfer through an axillary access: anatomical basis and clinical results. J Neurosurg 107:370–377. doi:10.3171/JNS-07/08/0370 PubMedCrossRef

11.

Kline DG, Kim DH (2003) Axillary nerve repair in 99 patients with 101 stretch injuries. J Neurosurg 99:630–636. doi:10.3171/jns.2003.99.4.0630 PubMedCrossRef

12.

Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am 28:633–638PubMedCrossRef

13.

Spinner RJ, Kline DG (2000) Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions. Muscle Nerve 23:680–695PubMedCrossRef

14.

Mallouhi A, Marik W, Prayer D et al (2012) 3T MR tomography of the brachial plexus: structural and microstructural evaluation. Eur J Radiol 81:2231–2245. doi:10.1016/j.ejrad.2011.05.021 PubMedCrossRef

15.

Birchansky S, Altman N (2000) Imaging the brachial plexus and peripheral nerves in infants and children. Semin Pediatr Neurol 7:15–25PubMedCrossRef

16.

O’Shea K, Feinberg JH, Wolfe SW (2011) Imaging and electrodiagnostic work-up of acute adult brachial plexus injuries. J Hand Surg Eur Vol 36:747–759. doi:10.1177/1753193411422313 PubMed

17.

Wellons JC, Tubbs RS, Pugh JA et al (2009) Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. J Neurosurg Pediatr 3:348–353. doi:10.3171/2008.11.PEDS08166 PubMedCrossRef

18.

Kawabata H, Shibata T, Matsui Y, Yasui N (2001) Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy. J Neurosurg 94:386–391. doi:10.3171/jns.2001.94.3.0386 PubMedCrossRef

19.

Kline DG, Tiel RL (2005) Direct plexus repair by grafts supplemented by nerve transfers. Hand Clin 21:55–69, vi. doi:10.1016/j.hcl.2004.09.002

Title: Oberlin transfer and partial radial to axillary nerve neurotization to repair an explosive traumatic injury to the Brachial Plexus in a child: Case report
Authors: Joseph H. Miller
Sarah T. Garber
Don E. McCormick
Ramin Eskandari
Marion L. Walker
Elias Rizk
R. Shane Tubbs
John C. Wellons
Publication date: 01-11-2013
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 11/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-013-2131-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oberlin transfer and partial radial to axillary nerve neurotization to repair an explosive traumatic injury to the Brachial Plexus in a child: Case report

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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