Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

Atakan Aydın,Ahmet Biçer,Zeynep Hoşbay Yıldırım,Türker Özkan,Berkan Mersa,Safiye Özkan

doi:10.1186/1471-2474-12-74

Atakan Aydın, Ahmet Biçer + Show 4 more

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https://doi.org/10.1186/1471-2474-12-74

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Abstract

BackgroundThe surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.MethodsA total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.ResultsIn the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.ConclusionsIn this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.

Highlights

The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed
In groups I, II, III, and IV, the mean abduction values increased by 70°, 71.5°, 58°, and 63°, respectively; whereas in groups I, II, III, and IV, the mean external rotation was increased by 8.1°, 48°, 45°, and 45°, respectively (Table 2)
Within the palliative surgery-only groups (III and IV), there were no significant differences between the preoperative and postoperative abduction and external rotation angles

Summary

Introduction

The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not. Obstetrical brachial plexus paralysis (OBPP) continues to be a challenge for developmental neurologists, physiotherapists, and hand surgeons all around the world, and its incidence is somehow increasing in developed countries. This increase has several possible explanations: an increased awareness of the disease, an presentation with functional deficits and/or deformity) [4,5]. Some authors suggest that the absence of biceps function at three months of age should be the threshold for early exploration, whereas others suggest that the absence of hand movements at three months and the absence of biceps functions at four months, or even later, should warrant exploration [4,5,6,7,8,9]

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