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Large experience in Asia has shown that the contralateral C7 nerve transfer has proved one of the major treatments for brachial plexus root avulsions. The authors report their experience in North America using the selective contralateral C7 transfer for neurotization of multiple targets.

In this study, children with obstetrical brachial plexus palsy who underwent various secondary reconstructions for shoulder stability and function were studied. The outcomes were analyzed in relation to the type of injury, the timing of surgery, and the type of secondary reconstruction.

In obstetrical brachial plexus palsy, suprascapular nerve reinnervation is a priority. For the most favorable outcomes in shoulder function, it is the authors’ policy to also reconstruct the axillary nerve with intraplexus donors to the posterior cord (early cases) or directly with intraplexus or extraplexus motor donors (late cases).

The authors' experience in the management of late ulnar nerve injuries is presented.

In children with global obstetric brachial plexus palsy, prioritization should be first focused on hand reinnervation and then directed to shoulder and elbow function. In this study, the surgical strategy for restoration of hand function and the methods and outcomes are analyzed.