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Outcome of Surgical Reconstruction After Traumatic Total Brachial Plexus Palsy

Dodakundi, Chaitanya MBBS, MS(Orth); Doi, Kazuteru MD, PhD; Hattori, Yasunori MD, PhD; Sakamoto, Soutetsu MD; Fujihara, Yuki MD; Takagi, Takehiko MD, PhD; Fukuda, Makoto MD

Journal of Bone & Joint Surgery - American Volume: 21 August 2013 - Volume 95 - Issue 16 - p 1505–1512
doi: 10.2106/JBJS.K.01279
Scientific Articles
Supplementary Content
Disclosures

Background: Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores.

Methods: Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure.

Results: The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of follow-up was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23° (range, 0° to 80°) for shoulder flexion, 31° (range, 0° to 90°) for shoulder abduction, −18° (range, −80° to 40°) for shoulder external rotation, 62° (range, 0° to 130°) for the shoulder rotation arc, 119° (range, 90° to 150°) for elbow flexion, and −33° (range, −60° to −20°) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was M0 in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46° (range, 0° to 98°), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure.

Conclusions: Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopedics, Ogori Daiichi General Hospital, 862-3 Shimogo-Ogori, Yamaguchi 754-0002, Japan. E-mail address for K. Doi: doimicro@saikyo.or.jp

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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