# Intraoperative Assessment of Nerve Traction Injury in Obstetric Brachial Plexus Palsy

## TL;DR

This paper introduces a classification system for nerve injuries during surgery for brachial plexus palsy in newborns, helping surgeons and other professionals assess and communicate nerve damage.

## Contribution

The paper introduces a new classification system combining macroscopic and microscopic indicators of nerve traction injury for surgical assessment.

## Key findings

- The classification includes signs like scarring, fascicular rupture, and dislocated ganglions.
- A grading system for microscopic tissue changes in traumatized nerve endings is proposed.
- The tools aim to improve communication among surgical and non-surgical professionals.

## Abstract

We present an easy classification for nerve lesions observed in reconstructive surgery for obstetric brachial plexus palsy, performed through a supraclavicular approach and systematic exposure of nerve roots and trunks. A description of signs related to nerve traction injury (scarring, fascicular rupture, and dislocated ganglions) is combined with a grading system of microscopic tissue changes occurring in slices from traumatized nerve endings (fascicular structure, changes in perineurium and endoneurium). Both tools are proposed for any surgical brachial plexus exploration and later interaction with other professionals (pediatricians, physiotherapists, or obstetricians).