Brachial plexus birth palsy Pediatric Research and Clinical Trials

For more than a century, orthopedic surgeons and investigators at Boston Children’s Hospital have played a vital role in the field of musculoskeletal research—pioneering treatment approaches and major advances in the care and treatment of trauma to the joint, scoliosis, polio, TB, hip dysplasias and traumas to the hand and upper extremities.

Our research helps answer the most pressing questions in pediatric orthopedics today—providing the children we treat with the most innovative care available.

Clinical studies for brachial plexus birth palsy

The natural history of brachial plexus birth palsy remains unknown, in part due to a lack of information on patients evaluated from birth to adulthood. Based on what’s currently known about BPBP, it’s generally accepted that microsurgery benefits infants:

•   without recovery of biceps function by the age of 6 months, and
•   with severe avulsion (a tear of the nerve at the spinal cord) injuries by 3 to 6 months of age

However, there’s significant controversy regarding the ideal timing for microsurgery whose long-term outcomes are unknown. The Brachial Plexus Program’s long-term TOBI (Treatment and Outcomes of Brachial Plexus Injury) study of BPBP treatment is an international effort that includes centers from North America, Europe and Australia.

Within Boston Children’s Orthopedic Center, the Brachial Plexus Program and the Clinical Effectiveness Research Center (CERC) are doing extensive research on brachial plexus birth palsy, including grant-funded research through the American Society for Surgery of the Hand (ASSH) and the Pediatric Orthopaedic Society of North America (POSNA). This includes coordinating and analyzing data on brachial plexus patients from centers throughout North America in the TOBI (Treatment and Outcomes Brachial Plexus Injuries) study.

The primary goal of this multi-center study is to determine the optimal age for microsurgical repair in infants with brachial plexus birth palsy and persistent upper extremity weakness. We’ll also compare the results of early microsurgery to those of secondary reconstructive surgery.

This research is an effort to establish a standard of care at all hospitals, and to determine the natural history (spontaneous recovery) and microsurgery results for brachial plexus injuries. Our program is coordinating this multi-center TOBI study over the next five years to determine the timing of microsurgery, tendon transfers and osteotomies.

We present all of our research papers on a national basis and publish these results in peer review journals. Numerous papers have already been published and presented in these areas and will continue to be published prospectively.

Please note: All patients with BPBP are invited to participate in this clinical study. During your visit with us, you will be approached by a research coordinator to participate in this and other studies—to help your child, you, and other children and parents determine what is best for infants and children with brachial plexus injuries.

Our Orthopedic Clinical Effectiveness Research Center (CERC)

The Clinical Effectiveness Research Center (CERC) was established by the Orthopedic Center to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and is playing an instrumental role in establishing, for the first time, evidence-based standards of care for pediatric orthopedic patients throughout the world.