The outcome of Erb's palsy when the decision to operate is made at 4 months of age.

Since the establishment of the obstetrical brachial plexus clinic in Saudi Arabia, the author has designed a prospective study in which the indication for brachial plexus surgery in infants with Erb's palsy was the lack of active elbow flexion against gravity at 4 months of age. Forty-three infants were included in the study and were distributed among four groups: group A (n = 20) included infants who had active elbow flexion at the initial assessment or at 2 months of age; group B (n = 9) included infants who had active elbow flexion at 3 months of age; group C (n = 11) included infants who had active elbow flexion at 4 months of age; and group D (n = 3) included infants who did not have active elbow flexion at 4 months of age. At the final follow-up, all children in group A demonstrated complete spontaneous recovery of the motor power of the limb. All children in group B also had satisfactory spontaneous recoveries, and none required secondary corrective procedures. Five of the 11 patients in group C had satisfactory spontaneous recoveries. The remaining six children in group C had good recovery of elbow flexion but a poor recovers of shoulder function. Finally, all three patients who did not have elbow flexion at 4 months of age (group D) underwent surgical exploration and reconstruction of the brachial plexus, using nerve grafts. The results of this prospective study are discussed, along with the controversial issue regarding the timing of primary plexus surgery in Erb's palsy.