Abstract
Objective:We evaluated the "extended" long-term (5 years) functional outcomes in obstetric brachial plexus injury (OBPI) patients, who underwent triangle tilt surgery between February 2005 and January 2008. Methods:Twenty two children (9 girls and 13 boys, mean age at surgery was 5.8 years; ranging 2.1-11.8 years old), who initially presented with medial rotation contracture and scapula deformity secondary to obstetric brachial plexus injury were included in this study. Functional movements were evaluated pre-operatively, and 5 years following triangle tilt surgery by modified Mallet scale. Results:Here, we report long-term (5 years) follow-up of triangle tilt surgery for 22 OBPI patients. Upper extremity functional movements such as, external rotation (2.5±0.6 to 4.1±0.8, p<0.0001), hand-to-spine (2.6±0.6 to 3.4±1.1, p<0.005), hand-to-neck (2.7±0.7 to 4.3±0.7, p<0.0001), hand-to-mouth (2.3±0.9 (92º±33) to 4.2±0.5 (21º±16), p<0.0001), and supination (2.6±1.1 (-8.2º ±51) to 4.1±0.7 (61±32)) were significantly improved (p<0.0001), and maintained over the extended long-term (5 years). Total modified Mallet functional score was also shown to improve from 14.1±2.7 to 20.3±2.5. Conclusions:The triangle tilt surgery improved all shoulder functions significantly, and maintained over the extended long-term (5 years) in these patients.
Highlights
Recent published epidemiological study identified an incidence of about 0.15% obstetric brachial plexus injury in live births in USA [1]
Objective: We evaluated the "extended" long-term (5 years) functional outcomes in obstetric brachial plexus injury (OBPI) patients, who underwent triangle tilt surgery between February 2005 and January 2008
Twenty two children (9 girls and 13 boys, mean age at surgery was 5.8 years; ranging 2.1-11.8 years old), who initially presented with medial rotation contracture and scapula deformity secondary to obstetric brachial plexus injury were included in this study
Summary
Recent published epidemiological study identified an incidence of about 0.15% obstetric brachial plexus injury in live births in USA [1]. Most injuries are transient and recover function spontaneously within the 3 months of life, some result in prolonged and persistent disability. Traditional approaches to treat OBPI are nerve and tendon transfers, muscle releases, axillary nerve decompression and derotational osteotomy of the humerus [3,4,5,6,7,8,9,10,11]. These surgical procedures may lead to better shoulder abduction and flexion, and improve the resting position of the arm. The triangle tilt surgery was developed by the surgeon (RKN) to mainly correct this bony deformity and shown to have a high success rate [13,14,15,16,17,18,19,20,21,22,23]
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