Amputation Level Recommendation on Brachial Plexus Insult

Amputation Level Recommendation on Brachial Plexus Insult

Derrick Kleiner, Resident

List Serve-
An interesting case came up in our practice.
Patient presented with a complete left brachial plexus injury secondary to a
MVA. The patient is considering an amputation. The patient was inquiring
about the best level of amputation. A transhumeral amputation with the shoulder
fused is 20 degrees of abduction and 30 degrees of flexion and maintaining
scapular control, is the most common recommendation in the early literature.
Has anyone experienced different level of amputations that yielded better
results? Experience with intercostals neurotization, muscle, or tendon transfer
to restore elbow flexion?
Then the question of viable prosthetic recommendation, several options
discussed: a microswitch of an externally powered prosthesis utilizing shoulder
elevation to operate electric elbow and electric terminal device, hybrid system
with passive elbow and myoelectrical control from the infraspinatus, or
microswitch to direct control to elbow, wrist or hand motors with myoelectrical
control.
Thank you for your time,
Derrick Kleiner
NCOPE Resident