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Functional Outcomes of Triple Nerve Transfers Compared to Traditional Nerve Grafting in Upper Trunk Obstetrical Brachial Plexus Injuries Open Access


Other title
obstetrical brachial plexus injuries
nerve transfers
Type of item
Degree grantor
University of Alberta
Author or creator
Supervisor and department
Dr. Jaret L. Olson, Co-supervisor, Division of Plastic Surgery, University of Alberta
Dr. K Ming Chan, Supervisor, Division of Physical Medicine and Rehabilitation, University of Alberta
Examining committee member and department
Dr. M Joe Watt, Committee member, Department of Pediatrics, University of Alberta
Dr. Nicola Cherry Committee member, Division of Preventative Medicine, University of Alberta
Dr. Justine Turner , Thesis defence examination chair, Department of Pediatrics, University of Alberta
Dr. Robertson Harrop, External examiner, Division of Plastic Surgery, University of Calgary
Medical Sciences-Paediatrics
Date accepted
Graduation date
Master of Science
Degree level
Children with obstetrical brachial plexus injuries may experience difficulties in some or all functional domains defined under the International Classification of Function. It can result in partial or complete paralysis of the arm. Secondary complications may include limb length discrepancy, and changes to the shoulder including glenoid deformity and posterior subluxation of humeral head. In addition to impacting body structure and function of the children, brachial plexus injuries can also affect the overall health and psychosocial condition of the children and their parents. In an effort to improve their arm function, different surgical options have been tried. Nerve reconstruction using sural nerve graft, popularized in the 1960s, still remains the gold standard. Although nerve transfers are widely done in the adult population with upper trunk brachial plexus injury, its role in children with obstetrical upper trunk brachial plexus injuries remains unclear. The main goal of this thesis is to evaluate the efficacy of the triple nerve transfer surgical procedure by comparing the functional outcomes and healthcare costs in a cohort of children with upper trunk brachial plexus injury. Fourteen children who received triple nerve transfers were compared to twelve children who received sural nerve grafting procedure using the Active Movement Scale as the primary outcome measure. We found that the triple nerve transfer group demonstrated significantly higher scores in shoulder external rotation, elbow flexion and forearm supination 2 years post operatively. In addition, they also demonstrated high scores on the Assisting Hand Assessment that measures how effectively the children can use the involved hand in bimanual activities. In terms of healthcare cost, the triple nerve transfer surgical technique required less surgical time, shorter hospital length of stay and less frequent need for secondary orthopaedic procedures. Based on these findings, we conclude that triple nerve transfers could be a useful option in the armamentarium of treatment for upper trunk obstetrical brachial plexus injuries.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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