Surgical Treatment of Obstetrical Brachial Plexus Paralysis: The Norfolk Experience
Bibliographic record
Abstract
In this article we present the outcomes of primary nerve reconstruction and results of secondary procedures performed to restore or enhance the function of the upper extremity. Ninety-nine patients were operated between 1978 and 2000; the results are analyzed for 84 patients with adequate follow-up. Seventy-five patients underwent 77 primary brachial plexus reconstructions and 24 patients underwent only secondary procedures. Nerve reconstruction included microneurolysis, direct end-to-end and direct end-to-side neurotizations, indirect neurotizations with interposition nerve grafting, and direct nerve-to-muscle neurotizations. Muscle ( n = 135 pedicled and 48 free) and tendon ( n = 80) transfers were used to enhance function. The results were analyzed in relation to the type of the injury (Erb's versus global paralysis) and the denervation time. The results of reconstruction showed improvement in all muscles tested at a statistically significant level ( p < 0.001). The results were good and excellent for 84.87% of biceps, 73.55% of supraspinatus, 71% of deltoid, and 67.8% of triceps restoration. The Mallet scores and the Gilbert-Raimondi scores improved after reconstruction in all patients at a statistically significant level. The outcomes in general were better if the number of avulsed roots was fewer. The denervation time (DT) affected primarily the outcome of the hand function. Patients with DT less than 3 months underwent less surgeries (1.3 surgeries per patient) to complete the reconstruction than patients with DT between 3 and 6 months (3.1 surgeries per patient). KEYWORDS Obstetrical brachial plexus palsy - nerve reconstruction - primary reconstruction - secondary reconstruction
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| 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".