Final Results of Grafting versus Neurolysis in Obstetrical Brachial Plexus Palsy
Bibliographic record
Abstract
BACKGROUND: The authors previously showed that neurolysis in obstetrical brachial plexus palsy resulted in improved function in some patients at 1 year's follow-up. In this study, the hypothesis that the long-term outcome of neuroma-in-continuity resection and nerve grafting yields better results than neurolysis was tested. METHODS: Obstetrical brachial plexus palsy patients treated with primary nerve surgery with a minimum follow-up of 4 years were studied. Patients were classified as undergoing neurolysis (n = 16) or resection and grafting (n = 92) and separated into Erb's or total palsy groups. The Active Movement Scale was used for patient evaluation. Changes in Active Movement Scale scores were analyzed using the Wilcoxon signed rank test. Fifteen movements were tested, and the proportion of patients in each group with scores deemed functionally useful (6 or 7) was compared using McNemar's exact test. RESULTS: After 4 years' follow-up, Erb's palsy neurolysis patients showed no improvement in function. Conversely, Erb's palsy grafting patients had improved function in seven movements. Total palsy neurolysis patients showed no improvement in function, whereas grafted patients showed improved function in 11 of 15 movements. CONCLUSIONS: Early improvements in function produced by neurolysis in Erb's palsy were not sustained over time. Neuroma-in-continuity resection and nerve grafting for both Erb's and total palsy produced significant improvements in Active Movement Scores and in the proportion of patients demonstrating functionally useful scores. Neurolysis as a complete surgical treatment for obstetrical brachial plexus palsy should be abandoned in favor of neuroma resection and nerve grafting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".