10-year Follow-up of Mod Quad and Triangle Tilt Surgeries in Obstetric Brachial Plexus Injury

Abstract

Aim: To evaluate whether obstetric brachial plexus injury (OBPI) children who had mod Quad and triangle tilt surgeries maintained their recovered upper extremity functional movements over 10 years. Background: The short-term outcomes of surgery in OBPI patients are well documented. However, only a few publications with results over 10-year postoperative follow-up exist. We have previously reported the outcomes of these 2 surgeries in OBPI after 1, 2, and 5 years. Here, we report the successful outcomes in 17 of these patients over 10 years. Methods: Seventeen OBPI patients, who had mod Quad, a modified muscle release operation and triangle tilt, a bony surgical procedure with us between 2005 and 2008, had postoperative follow-up of 10 years and met the inclusion criteria. Patients who had multiple surgeries and did not have 10-year follow-up are excluded in this study. Results: Fifteen of 17 children maintain their recovered upper extremity functions for extended long period (mean, 10 years; range, 9–13 years). There was statistically significant improvement in total functional Mallet score after 3 years (mean, 18.8 ± 2.1; P ≤ 0.01) from the preoperative mean total Mallet score of 14.5 ± 1.2. This improvement was not only maintained for extended period but also improved (mean total Mallet score, 20.35 ± 2.3; P ≤ 0.01) in some patients. Conclusions: Overall, all upper extremity functions improved greatly after mod Quad and triangle tilt surgeries in OBPI children, and they were able to maintain their recovered functional movements over extended period of 10 years.

Birth Injury, Duchenne-Erbʼs Obstetric Palsy. Diagnosis and Treatment (Literature Review)

“…With the development of surgery, arthroscopic surgical interventions on the shoulder joint began to be used for the treatment of abnormalities. A number of authors reported in a retrospective analysis of the treatment of children with shoulder monoparesis by shoulder arthroscopy that the criteria for the use of arthroscopy are as follows: limitation of external rotation, shoulder abduction, the initial stage of glenoid dysplasia (Water's dysplasia scale I-IV) [71]. The operation involved partial anterior capsulotomy of the shoulder joint, lengthening of the medial glenohumeral ligament, and partial tenotomy of the subscapularis muscle tendon.…”

“…Statistically, there was an improvement in the overall Mallet functional score, the average value being 18.8 ± 2.1; p ≤ 0.01 compared to the preoperative mean total Mallet score of 14.5 ± 1.2. Functional improvement was not only maintained for a long period, but also improvedthe average total Mallet score (20.35 ± 2.3; p ≤ 0.01) [71,72]. In 2015, a meta-analysis was carried out on the use of derotation osteotomy of the shoulder in comparison with the «Triangle Tilt» technique.…”

Examination of Upper Extremity Length Discrepancy in Patients with Obstetric Brachial Plexus Paralysis

“…These results supported the hypothesis that untreated obstetric brachial plexus injury could have a sustained, progressive adverse effect on limb growth-and that surgical intervention for obstetric brachial plexus injury could improve limb growth potential. Shortness of more than 5 cm, which may develop due to deficiencies in treatment modalities, can reduce the quality of life, both cosmetically and functionally [35,36]. In the treatment of this limb shortness, treatments such as the Ilizarov method, which are used in the treatment of lower extremity shortness, could be applied.…”