Obstetrical brachial plexus injury is rare; however, it leads to significant functional limitations in children who do not experience spontaneous recovery. A modified L’Episcopo procedure in conjunction with a postoperative protocol that includes a custom adjustable rotation/abduction orthosis can produce an exceptional result with significant functional improvement. The University of Michigan’s Department of Orthopaedic Surgery is performing modified L’Episcopo procedures on children as young as 18 months with continued success and adherence to the postoperative protocol. Use of an appropriately fitting custom orthosis as part of the postoperative regimen for an already well-documented successful surgical procedure produces the optimum clinical success and may eliminate the need for postoperative spica casting, which presents significant benefit to the child and the caregiver.
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