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Archives of Orthopaedic and Trauma Surgery

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01-12-2010 | Orthopaedic Surgery

Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children with persistent obstetric brachial plexus palsy

Authors: Marcin Sibiński, Marek Synder

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2010

Abstract

Introduction

Children with obstetric brachial plexus palsy (OBPP) frequently have problems related to their shoulder. The aim of the investigation was to determine our results in treating shoulder deformity with tendon transfers and soft tissue releases with and without internal rotational osteotomy. We also evaluated the relationships between neurological status, age and selected clinical parameters.

Materials and methods

We reviewed data of 25 patients (12 girls) after latissimus dorsi and teres major tendon transfers to the rotator cuff. Internal rotation osteotomy was performed in ten children. The mean age of patients at the time of operation was 3.2 years (range from 10 months to 7.7 years).

Result

Patients were followed up for a mean of 3.8 years (minimum 2 years). Mallet score improved 4.7 points at last follow-up (p = 0.00002). No patient had shoulder function deterioration. Active and passive external rotation increased significantly after operation: p < 0.00001, p < 0.00001, respectively. Statistically significant reduction in active internal rotation was noted (p = 0.04). The other movements have not statistically changed after operation. Active internal rotation difference after internal rotation osteotomy was significantly better than without osteotomy (p = 0.03). Neurological involvement and age had neither positive nor negative influence on final range of motion and outcome.

Conclusions

Soft tissue rebalancing procedures significantly improve shoulder function in children with persistent OBPP. Addition of internal rotational osteotomy to muscle transfers for severe cases allows maintaining of stabile joint, prevents loosening of internal rotation and does not influence other movements of the shoulder.

Al-Qattan MM (2003) Latissimus dorsi transfer for external rotation weakness of the shoulder in obstetric brachial plexus palsy. J Hand Surg Br 28:487–490CrossRefPubMed

Chuang DC, Ma HS, Wei FC (1998) A new strategy of muscle transposition for treatment of shoulder deformity caused by obstetric brachial plexus palsy. Plast Reconstr Surg 101:686–694CrossRefPubMed

Kirkos JM, Kyrkos MJ, Kapetanos GA, Haritidis JH (2005) Brachial plexus palsy secondary to birth injuries. J Bone Jt Surg Br 87:231–235CrossRef

Pagnotta A, Haerle M, Gilbert A (2004) Long-term results on abduction and external rotation of the shoulder after latissimus dorsi transfer for sequelae of obstetric palsy. Clin Orthop Relat Res 426:199–205CrossRefPubMed

Pearl ML, Edgerton BW, Kazimiroff PA, Burchette RJ, Wong K (2006) Arthroscopic release and latissimus dorsi transfer for shoulder internal rotation contractures and glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Jt Surg Am 88:564–574CrossRef

Phipps GJ, Hoffer MM (1995) Latissimus dorsi and teres major transfer to rotator cuff for Erb’s palsy. J Shoulder Elbow Surg 4:124–129CrossRefPubMed

Waters PM, Bae DS (2005) Effect of tendon transfers and extra-articular soft-tissue balancing on glenohumeral development in brachial plexus birth palsy. J Bone Jt Surg Am 87:320–325CrossRef

Waters PM, Peljovich AE (1999) Shoulder reconstruction in patients with chronic brachial plexus birth palsy. A case control study. Clin Orthop Relat Res 364:144–152CrossRefPubMed

Terzis JK, Vekris MD, Okajima S, Soucacos PN (2003) Shoulder deformities in obstetric brachial plexus paralysis: a computed tomography study. J Pediatr Orthop 23:254–260CrossRefPubMed

10.

Narakas AO (1987) Obstetrical brachial plexus injuries. In: Lamb DW (ed) The paralysed hand. Churchill Livingstone, Edinburgh, pp 116–135

11.

Mallet J (1972) Primaute du traitement de l’epaule—methode d’expression des resultants. Rev Chir Orthop Reparatrice Appar Mot 58(Suppl 1):166–168PubMed

12.

Kozin SH, Chafetz RS, Barus D, Filipone L (2006) Magnetic resonance imaging and clinical findings before and after tendon transfers about the shoulder in children with residual brachial plexus birth palsy. J Shoulder Elbow Surg 15:554–561CrossRefPubMed

13.

Hui JH, Torode IP (2003) Changing glenoid version after open reduction of shoulders in children with obstetric brachial plexus palsy. J Pediatr Orthop 23:109–113CrossRefPubMed

14.

Pedowitz DI, Gibson B, Williams GR, Kozin SH (2007) Arthroscopic treatment of posterior glenohumeral joint subluxation resulting from brachial plexus birth palsy. J Shoulder Elbow Surg 16:6–13CrossRefPubMed

15.

Savva N, McAllen CL, Giddins GE (2003) The relationship between the strength of supination of the forearm and rotation of the shoulder. J Bone Jt Surg Br 85:406–407CrossRef

Title: Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children with persistent obstetric brachial plexus palsy
Authors: Marcin Sibiński
Marek Synder
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2010
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-010-1067-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children with persistent obstetric brachial plexus palsy

Abstract

Introduction

Materials and methods

Result

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Result

Conclusions

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