Oberlin transfer and partial radial to axillary nerve neurotization to repair an explosive traumatic injury to the Brachial Plexus in a child: Case report

Purpose: Explosive injuries to the pediatric brachial plexus are exceedingly rare and as such are poorly characterized in the medical literature. Methods: Herein, we describe an 8-year-old who was struck in the neck by a piece of shrapnel and suffered multiple vascular injuries in addition to a suspected avulsion of the cervical 5 and 6 ventral rami. The patient had a complete upper brachial plexus palsy and failed to demonstrate any clinical improvement at 6-months follow-up. He was taken to the operating from for a partial ulnar to musculocutaneous nerve neurotization as well as a partial radial to axillary nerve neurotization. Results: The patient's motor exam improved from a Medical Research Council scale 1 to 4+ for biceps brachii and 0 to 4 deltoid function with greater than 90 of shoulder abduction. Conclusions: This outcome supports complex neurotization techniques as viable treatment options for persistent motor deficits following an upper brachial plexus injury in older, non-infant age, children.