Cassidy, Jeff; Clarke, Michael
Purpose of review:
To review the literature over the past year regarding pediatric upper extremity trauma, brachial plexus birth palsy and neuromuscular involvement of the upper extremity. Relevant studies are discussed as well as their potential impact on current practices.
Elbow fractures continue to be a major focus of the pediatric upper extremity trauma literature. There have been numerous reports on the optimal treatment, timing and pin configuration of supracondylar humerus fractures. Forearm fractures are among the most common injuries of childhood. A large study from the Mayo clinic found that the incidence of forearm fractures has been steadily increasing over the past three decades. Several reports confirm the success of intramedullary fixation of select forearm fractures. The optimal treatment for brachial plexus birth palsy remains controversial, however new data suggest that complete neurologic recovery is less frequent than previously thought and that complete lesions may benefit from early surgical exploration and repair. There are several reports on the management of contractures from birth palsy and a description of early shoulder dislocation with progressive glenoid dysplasia. Improved cosmetic and functional outcomes have been shown with both surgical and non-surgical means in the treatment of children with neuromuscular disorders and upper extremity spasticity.
There have been no groundbreaking advances in the management of pediatric upper extremity trauma, however several studies reaffirm current practices. Brachial plexus birth palsy remains an extremely difficult condition to treat, however evidence suggests early surgical exploration and treatment of complete lesions may be beneficial. Children may also benefit from early and aggressive treatment of shoulder deformities and other sequelae of brachial plexus birth palsy. Upper extremity spacticity can be effectively managed by nonsurgical means, however surgical intervention can effectively improve functional and cosmetic outcome.
Current Opinion in Orthopedics. 15(6):434-438, December 2004.