Obstetrical brachial plexus palsy (OBPP) remains a dramatic consequence after complicated childbirth. An increasing number of methods are being developed for the physical therapy and the early repair of the nerve lesions in OBPP, including neuroma excision and nerve grafting, neurolysis and neurotization. Secondary deformities of the shoulder, forearm, and hand can be reconstructed using soft tissue and skeletal procedures. In this article we analyze our approach to 105 patients to obtain optimal functional outcome in patients with OBPP.