Management strategies for shoulder reconstruction in obstetric brachial plexus injury with special reference to loss of internal rotation after surgery

We assessed the outcomes in 24 of 25 children (mean age 3 years) who had soft-tissue shoulder reconstruction procedures for obstetric brachial plexus injuries. All had latissimus dorsi and teres major transfers to strengthen external rotation combined with subscapularis lengthening, reduction of pos...

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Bibliographic Details
Published in:The Journal of hand surgery, European volume European volume, 2012-10, Vol.37 (8), p.772-779
Main Authors: Sibinski, M., Hems, T. E. J., Sherlock, D. A.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Brachial Plexus Neuropathies - physiopathology
Brachial Plexus Neuropathies - surgery
Child
Child, Preschool
Diseases of the osteoarticular system
Female
Humans
Infant
Joint Deformities, Acquired - physiopathology
Joint Deformities, Acquired - surgery
Male
Medical sciences
Muscle, Skeletal - transplantation
Nervous system (semeiology, syndromes)
Nervous system as a whole
Neurology
Orthopedic surgery
Osteotomy
Prospective Studies
Range of Motion, Articular - physiology
Reconstructive Surgical Procedures - methods
Rotation
Shoulder Joint - injuries
Shoulder Joint - physiopathology
Shoulder Joint - surgery
Statistics, Nonparametric
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Treatment Outcome
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Description
Summary:We assessed the outcomes in 24 of 25 children (mean age 3 years) who had soft-tissue shoulder reconstruction procedures for obstetric brachial plexus injuries. All had latissimus dorsi and teres major transfers to strengthen external rotation combined with subscapularis lengthening, reduction of posterior dislocation or subluxation, and humeral osteotomy, if necessary. At a mean follow-up of 3.8 years, the mean Mallet score improved from 12.3 preoperatively to 17.4 postoperatively, active external rotation improved from 21° to 32°, and passive external rotation improved from 26° to 67°. The shoulder remained in joint in all patients. Active internal rotation deteriorated in nine shoulders, two requiring secondary internal rotation osteotomy. Combined soft tissue rebalancing and bony procedures gives reliable shoulder function improvement. Care is required regarding the effect on internal rotation.
ISSN:1753-1934
2043-6289
DOI:10.1177/1753193412440221