The hand surgeon is frequently involved in the medicolegal assessment of birth palsy cases. Although brachial plexus injury has been reported in newborns delivered by Caesarean section, it is difficult to determine if these cases are due to excessive force when delivering the infant from the uterus or whether the palsy is related to other factors. We have studied our series of 16 cases of obstetrical brachial plexus palsy with special attention to the newborn baby delivered by Caesarean section. We have reviewed the English literature over the last decade and found that birth palsy in newborns delivered by Caesarean section is extremely rare (1% of all birth palsy cases). The differentiation between brachial plexus injury caused by forcible delivery and congenital upper limb palsy from other causes is discussed.
Median nerve to biceps nerve transfer in the arm has been reported only in adults. The following paper reports on 10 cases of this transfer in obstetric brachial plexus palsy. All patients had upper palsy (ERb's or extended ERb's palsy) and presented to the author late (13–19 months of age) with poor or no recovery of elbow flexion. Following the nerve transfer, nine children recovered elbow flexion (a score of 6 in one child and a score of 7 in eight children by the Toronto scale). The remaining child did not recover elbow flexion.
Two cases of obstetrical brachial plexus injury in subsequent deliveries in the same family are described. Medicolegal aspects, review of the literature and recommendations regarding its prevention are given.
Surg 1996;4(4):203-204. Two cases of obstetrical brachial plexus injury in subsequent deliveries in the same family are described. Medicolegal aspects, review of the literature and recommendations regarding its prevention are given. Lésion obstétricals du plexus brachial lors des accouchements subséquentsRÉSUMÉ : Deux cas de lésions obstéricales du plexus brachial lors d'accouchements subséquents dans une même famille sont décrits ici. Les aspects médico-légaux, une revue de la littérature et des recommandations au sujet de sa prévention sont également présentés.Obstetric brachial plexus injury has gained recent attention in the plastic surgery literature because of advances in microsurgery and nerve reconstruction (1-8). Brachial plexus birth palsy is a relatively rare injury and occurs in about one in every 1000 live births. In the modern literature, it is rare to find more than one affected child in the same family. In this paper, we report on obstetric palsy in two subsequent deliveries from the same woman. Medicolegal aspects, a review of the literature and recommendations for prevention of this injury are discussed. CASE PRESENTATIONS Case 1A four-year-old girl presented to the brachial plexus clinic in Riyadh, Saudi Arabia with residual left total birth palsy. She was born vaginally at another institution after a full term uncomplicated pregnancy. The presentation was vertex, and delivery was difficult and complicated by shoulder dystocia. At birth, left total birth palsy and an ipsilateral clavicular fracture were evident. Birth weight was 4.4 kg. Good recovery of the motor power occurred, but the functional use of the limb was impaired because of an internal rotation contracture of the shoulder. Rotation osteotomy of the humerus was performed with no complications. Case 2A two-year-old boy (brother of case 1) presented at the brachial plexus clinic in Riyadh with residual left Erb's palsy. He was born vaginally at another institution (same CAN
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