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Comparing the Surgical Outcomes of Modified Quad and Triangle Tilt Surgeries to other Procedures Performed in Obstetric Brachial Plexus Injury

DOI: 10.4236/ss.2013.49A003, PP. 15-21

Keywords: Obstetric Brachial Plexus Injury, Triangle Tilt Surgery, Modified Quad Surgery, Modified Mallet, Radiological Score

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Abstract:

Purpose: To compare results from our surgical treatment experiences in children with obstetric brachial plexus injuries (OBPI), to those who have had other surgical treatments. Methods: We conducted a retrospective study in our medical records consisting of two groups of OBPI patients. Group 1: 26 OBPI children (16 girls and 10 boys), age range between 2.0 and 12.0 (mean age 6.9), who have undergone surgical treatments at other institutions between 2005 and 2010. Group 2: 45 OBPI children (20 boys and 25 girls), age between 0.7 and 12.9 (mean age 3.7), who have had modified Quad and triangle tilt surgical treatment between 2005 and 2010 at our institution. In both groups Mean modified Mallet scores and radiological scores were measured and compared. All measurements were made at least one year post surgery in both groups. Results: Post-operative mean modified Mallet score was 11.8 ± 2.4 in group 1 patients, whereas post-mean modified Mallet score was 20 ± 2.7 (P < 0.0001) following modified Quad and triangle tilt surgeries in group 2 patients. Further, their radiological scores such as posterior subluxation, and glenoid version were 13.4 ± 21.3 and 30.2 ± 19.1 in group 1, whereas 32.1 ±13.5 (P < 0.0004), and 16.3 ± 11.5 (P < 0.008) in group 2 patients, when compared to normal values of 50, and 0 respectively. Conclusion: Patients who have had mod Quad and triangle tilt for OBPI obtained significantly better functional outcomes in modified total Mallet score as well as in radiological scores, when compared to those OBPI children, who underwent other procedures such as posterior glenohumeral capsulorrhaphy, biceps tendon lengthening, humeral osteotomy, anterior capsule release, nerve transfer/graft, botox and muscle/tendon transfer and release.

References

[1]  J. B. Adler and R. L. Patterson Jr., “Erb’s Palsy. Long-Term Results of Treatment in Eighty-Eight Cases,” The Journal of Bone and Joint Surgery (American Volume), Vol. 49, No. 6, 1967, pp. 1052-1064.
[2]  A. F. Hoeksma, H. Wolf and S. L. Oei, “Obstetrical Brachial Plexus Injuries: Incidence, Natural Course and Shoulder Contracture,” Clinical Rehabilitation, Vol. 14, No. 5, 2000, pp. 523-526. doi:10.1191/0269215500cr341oa
[3]  S. L. Foad, C. T. Mehlman and J. Ying, “The Epidemiology of Neonatal Brachial Plexus Palsy in the United States,” The Journal of Bone and Joint Surgery (American Volume), Vol. 90, No. 6, 2008, pp. 1258-1264. doi:10.2106/JBJS.G.00853
[4]  E. D. Gurewitsch, E. Johnson, S. Hamzehzadeh and R. H. Allen, “Risk Factors for Brachial Plexus Injury with and without Shoulder Dystocia,” American Journal of Obstetrics & Gynecology, Vol. 194, No. 2, 2006, pp. 486-492. doi:10.2106/JBJS.G.00853
[5]  R. Birch, G. Bonney and C. B. Wynn Parry, “Birth Lesions of the Brachial Plexus,” In: R. Birch, G. Bonney and C. B. Wynn Parry, Eds., Surgical Disorders of the Peripheral Nerves, Churchill Livingstone, New York, 1998, pp. 209-233.
[6]  A. Gilbert and J. L. Tassin, “Surgery Repair of the Brachial Plexus after Obstetric Paralysis,” Chirurgie, Vol. 110, No. 1, 1984, pp. 70-75.
[7]  R. Birch, “Late sequelae at the shoulder in obstetrical palsy in children,” In: M. Randelli and J. Karlsson, Eds., Surgical Techniques in Orthopaedics and Traumatology, Elsevier, Paris, 2001, pp. 55-200-E-210.
[8]  D. S. Kon, A. B. Darakjian, M. L. Pearl and A. E. Kosco, “Glenohumeral Deformity in Children with Internal Rotation Contractures Secondary to Brachial Plexus Birth Palsy: Intraoperative Arthrographic Classification,” Radiology, Vol. 231, No. 3, 2004, pp. 791-795. doi:10.1148/radiol.2313021057
[9]  J. A. van der Sluijs, W. J. van Ouwerkerk, A. de Gast, P. I. Wuisman, F. Nollet and R. A. Manoliu, “Deformities of the Shoulder in Infants Younger than 12 Months with an Obstetric Lesion of the Brachial Plexus,” The Journal of Bone & Joint Surgery (British Volume), Vol. 83, No. 4, 2001, pp. 551-555. doi:10.1302/0301-620X.83B4.11205
[10]  R. K. Nath, S. E. Mackinnon, J. N. Jensen and W. C. Parks, “Spatial Pattern of Type I Collagen Expression in Injured Peripheral Nerve,” Journal of Neurosurgery, Vol. 86, No. 5, 1997, pp. 866-870. doi:10.3171/jns.1997.86.5.0866
[11]  R. Birch, “Obstetric Brachial Plexus Palsy,” Journal of Hand Surgery (British Volume), Vol. 27B, No. 1, 2002, pp. 3-8.
[12]  P. M. Waters, “Obstetric Brachial Plexus Injuries: Evaluation and Management,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 5, No. 4, 1997, pp. 205-214.
[13]  S. M. Shenaq, J. Y. Kim, A. H. Armenta, R. K. Nath, E. Cheng and A. Jedrysiak, “The Surgical Treatment of Obstetric Brachial Plexus Palsy,” Plastic and Reconstructive Surgery, Vol. 113, No. 4, 2004, pp. 54E-67E. doi:10.1097/01.PRS.0000110215.61220.72
[14]  R. K. Nath, C. Somasundaram and F. Mahmooduddin, “Comparing Functional Outcome of Triangle Tilt Surgery Performed before versus after Two Years of Age,” The Open Orthopaedics Journal, Vol. 5, 2011, pp. 59-62. doi:10.1097/01.PRS.0000110215.61220.72
[15]  M. M. Al-Qattan, “Latissimus Dorsi Transfer for External Rotation Weakness of the Shoulder in Obstetric Brachial Plexus Palsy,” Journal of Hand Surgery (British Volume), Vol. 28, No. 5, 2003, pp. 487-490. doi:10.1097/01.PRS.0000110215.61220.72
[16]  T. A. El-Gammal, W. R. Saleh, A. El-Sayed, M. M. Kotb, H. M. Imam and N. A. Fathi, “Tendon Transfer Around the Shoulder in Obstetric Brachial Plexus Paralysis: Clinical and Computed Tomographic Study,” Journal of Pediatric Orthopaedics, Vol. 26, No. 5, 2006, pp. 641-646. doi:10.1097/01.PRS.0000110215.61220.72
[17]  R. K. Nath and M. Paizi, “Improvement in Abduction of the Shoulder after Reconstructive Soft-Tissue Procedures in Obstetric Brachial Plexus Palsy,” The Journal of Bone & Joint Surgery (British Volume), Vol. 89, No. 5, 2007, pp. 620-626. doi:10.1097/01.PRS.0000110215.61220.72
[18]  A. Pagnotta, M. Haerle and A. Gilbert, “Long-Term Results on Abduction and External Rotation of the Shoulder after Latissimus Dorsi Transfer for Sequelae of Obstetric Palsy,” Clinical Orthopaedics and Related Research, Vol. 426, 2004, pp. 199-205. doi:10.1097/01.PRS.0000110215.61220.72
[19]  Y. Safoury, “Muscle Transfer for Shoulder Reconstruction in Obstetrical Brachial Plexus Lesions,” Handchirurgie Mikrochirurgie Plastische Chirurgie, Vol. 37, No. 5, 2005, pp. 332-336. doi:10.1055/s-2005-872818
[20]  J. A. van der Sluijs, W. J. van Ouwerkerk, A. de Gast, F. Nollet, H. Winters and P. I. Wuisman, “Treatment of Internal Rotation Contracture of the Shoulder in Obstetric Brachial Plexus Lesions by Subscapular Tendon Lengthening and Open Reduction: Early Results and Complications,” Journal of Pediatric Orthopaedics B, Vol. 13, No. 3, 2004, pp. 218-224. doi:10.1055/s-2005-872818
[21]  P. M. Waters and D. S. Bae, “The Early Effects of Tendon Transfers and Open Capsulorrhaphy on Glenohumeral Deformity in Brachial Plexus Birth Palsy,” The Journal of Bone and Joint Surgery (American Volume), Vol. 90, No. 10, 2008, pp. 2171-2179. doi:10.2106/JBJS.G.01517
[22]  P. M. Waters and D. S. Bae, “Effect of Tendon Transfers and Extra-Articular Soft-Tissue Balancing on Glenohumeral Development in Brachial Plexus Birth Palsy,” The Journal of Bone and Joint Surgery (American Volume), Vol. 87, No. 2, 2005, pp. 320-325. doi:10.2106/JBJS.G.01517
[23]  R. K. Nath, M. B. Avila and P. Karicherla, “Triangle Tilt Surgery as Salvage Procedure for Failed Shoulder Surgery in Obstetric Brachial Plexus Injury,” Pediatric Surgery International, Epub Ahead of Print, 2010.
[24]  R. K. Nath, A. Amrani, S. E. Melcher, M. J. Wentz and M. Paizi, “Surgical Normalization of the Shoulder Joint in Obstetric Brachial Plexus Injury,” Annals of Plastic Surgery, Vol. 65, No. 4, 2010, pp. 411-417.
[25]  R. K. Nath, A. Amrani, S. E. Melcher and M. G. Eichhorn, “Triangle Tilt Surgery in an Older Pediatric Patient with Obstetric Brachial Plexus Injury,” Eplasty, Vol. 9, 2009, p. e26.
[26]  R. K. Nath, A. Amrani, S. E. Melcher, M. J. Wentz and M. Paizi, “Surgical Normalization of the Shoulder Joint in Obstetric Brachial Plexus Injury,” Annals of Plastic Surgery, Vol. 65, No. 4, pp. 411-417. doi:10.1097/SAP.0b013e3181e1335b
[27]  R. K. Nath, M. B. Avila, P. Karicherla and C. Somasundaram, “Assessment of Triangle Tilt Surgery in Children with Obstetric Brachial Plexus Injury Using the Pediatric Outcomes Data Collection Instrument,” Open Orthopaedics Journal, Vol. 5, No. 12, 2011, pp. 385-388.
[28]  R. K. Nath, X. Liu, S. E. Melcher and J. Fan, “LongTerm Outcomes of Triangle Tilt Surgery for Obstetric Brachial Plexus Injury,” Pediatric Surgery International, Vol. 26, No. 4, 2010, pp. 393-399. doi:10.1007/s00383-010-2550-4
[29]  R. K. Nath and F. Mahmooduddin, “Triangle Tilt Surgery: Effect on Coracohumeral Distance and External Rotation of the Glenohumeral Joint,” Eplasty, Vol. 10, No. 11, 2010, p. e67.
[30]  R. K. Nath, S. E. Melcher, A. B. Lyons and M. Paizi, “Surgical Correction of the Medial Rotation Contracture in Obstetric Brachial Plexus Palsy,” The Journal of Bone & Joint Surgery (British Volume), Vol. 89, No. 12, 2007, pp. 1638-1644. doi:10.1302/0301-620X.89B12.18757
[31]  R. K. Nath, S. E. Melcher and M. Paizi, “Surgical Correction of Unsuccessful Derotational Humeral Osteotomy in Obstetric Brachial Plexus Palsy: Evidence of the Significance of Scapular Deformity in the Pathophysiology of the Medial Rotation Contracture,” Journal of Brachial Plexus and Peripheral Nerve Injury, Vol. 1, No. 12, 2006, p. 9. doi:10.1302/0301-620X.89B12.18757
[32]  R. K. Nath, C. Somasundaram and F. Mahmooduddin, “Triangle Tilt and Steel Osteotomy: Similar Approaches to Common Problems,” The Open Orthopaedics Journal, Vol. 5, No. 2011, pp. 124-133. doi:10.1302/0301-620X.89B12.18757
[33]  R. K. Nath, C. Somasundaram, S. E. Melcher, M. Bala and M. J. Wentz, “Arm Rotated Medially with Supination —The Arms Variant: Description of Its Surgical Correction,” BMC Musculoskeletal Disorders, Vol. 10, No. 3, 2009, p. 32. doi:10.1186/1471-2474-10-32
[34]  R. J. Friedman, K. B. Hawthorne and B. M. Genez, “The Use of Computerized Tomography in the Measurement of Glenoid Version,” The Journal of Bone and Joint Surgery (American Volume), Vol. 74, No. 7, 1992, pp. 1032-1037.
[35]  R. K. Nath and M. Paizi, “Scapular Deformity in Obstetric Brachial Plexus Palsy: A New Finding,” Surgical and Radiologic Anatomy, Vol. 29, No. 2, 2007, 133-140. doi:10.1007/s00276-006-0173-1
[36]  R. K. Nath and C. Somasundaram, “Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy,” Eplasty, Vol. 12, No. 12, 2012, p. e54.

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