Pediatric Traumatic Brachial Plexus Injuries

Compared to brachial plexus birth injuries (BPBI) and adult traumatic brachial plexus injuries (BPI), traumatic brachial plexus injuries in children are less common, infrequently reported, and are surrounded by controversy regarding optimal treatment. Patient evaluation commences with a thorough history and physical examination of sensory and strength deficits. Imaging and electrodiagnostic studies aid decision-making and formation of an operative plan. Depending on the size and age of the child, priorities of reconstruction are typically restoration of elbow flexion, shoulder stability/external rotation and rudimentary hand function. Primary reconstruction with neuroma excision and nerve grafting, intra-plexal and extra-plexal nerve transfers, and free-functioning muscle transfers have all been utilized to achieve these goals. Secondary surgeries include tendon transfers, selective fusions, and in some patients, amputation with myoelectric prosthetic fitting may be considered. Unlike brachial plexus birth injuries, surgical reconstruction is directed at elbow flexion and not hand function, outcomes are not as optimistic, and associated severe neuropathic pain remains a challenge. Further studies of pediatric traumatic BPI with follow-up into adulthood may improve our understanding of how to treat these injuries and may change the reconstructive paradigm.