Assessment of Triangle Tilt Surgery in Children with Obstetric Brachial Plexus Injury Using the Pediatric Outcomes Data Collection Instrument

Abstract

Background:The benefits of triangle tilt surgery in children with OBPI have been previously validated through measurements of statistical improvements in Mallet scores and in glenohumeral congruity. The purpose of the current study was to evaluate the effectiveness of triangle tilt surgery through the application of the Pediatric Outcomes Data Collection Instrument, a well validated questionnaire designed to evaluate function and comfort in children with musculoskeletal disorders.Methods:OBPI patients between 2 and 10 years of age who came to our institute for routine office visits between May 2009 and October 2009 were considered to participate in the study. Among the patient group, the first 130 completed surveys who met the study criteria were included in the study. The Pediatric Outcomes Data Collection Instrument was completed by the parents of patients who have undergone triangle tilt surgery (Group 1: N=63) or those who were considered candidates for this procedure (Group 2: N=67). The results were compared between the two patient groups and analyzed using the unpaired student’s t-test. Later, 23 patients from the group 2, underwent triangle tilt surgery (Group 3). We collected post-op data, compared and analyzed the outcome of the surgery in these patients to their own pre-op PODCI scores, using the paired student’s t test.Results:In patients who have undergone triangle tilt surgery, significantly higher PODCI scores were observed in the parameters of upper extremity function (p<0.05), sports/physical function (p<0.05), basic mobility (p<0.0001) and global functioning (p<0.05), when compared to patients who have not undergone triangle tilt surgery. Further, PODCI scores in group 3 patients were significantly higher after surgery in the parameters of upper extremity function (p <0.03), Pain/Comfort (p <0.05), basic mobility (p<0.0002) and global functioning (p<0.03), when compared to before triangle tilt surgery.Conclusion:The results of the Pediatric Outcomes Data Collection Instrument demonstrate the functional benefits of triangle tilt surgery in patients with obstetric brachial plexus injury.

Comparing the psychometric properties of the pediatric outcomes data collection instrument and the Activities Scales for Kids

“…These are two general popular musculoskeletal instruments that examine the functional ability of children with problems such as upper extremity deficiencies, hand and wrist acute injuries, scoliosis, kyphosis, obstetric brachial plexus injury, and so on (e.g. Lerman et al, 2002Lerman et al, , 2005Nath et al, 2011).…”

Health‐Related Quality of Life Components in Children With Neonatal Brachial Plexus Palsy: A Qualitative Study

“…Existing measures for children with NBPP mainly focus on physical examinations such as muscle power and range of motion without indication of how these physical factors affect daily activities or psychosocial well‐being. Furthermore, generic physician‐developed measures such as the Child Health Questionnaire and Pediatric Outcomes Data Collection Instrument fail to capture comprehensive NBPP physical, emotional, and social concerns or NBPP‐specific issues, such as sensory and body image perception [14‐18]. It is critical to understand the patient's perspective of their condition to better understand the natural course of the disease, its impact on HRQOL during child development, as well as the effectiveness of interventions to improve HRQOL.…”

Surgical Management of Obstetric Brachial Plexus Palsy Secondary Deformities

“…Restoration of glenohumeral congruity is therefore a primary objective in treating OBPI, which then allows for maximum functional range of motion and improved limb growth. A bony surgical procedure, Triangle Tilt (figure 5) [42,44,[57][58][59][60][61][62][63][64][65][66] was therefore developed by the lead author and surgeon (RKN). This triangle tilt detaches the distal acromio-clavicular triangle-humeral head complex from the abnormally positioned scapula, and tilts the acromio-clavicular plane back to neutral position.…”

“…This relieves the impingement of the acromio-clavicular triangle on the humeral head. and allows the head to be repositioned passively into a neutral position within the glenoid fossa ( Figure 5), resulting in improved gleno-humeral joint congruency [42,44,[57][58][59][60][61][62][63][64][65][66].…”

“…We have demonstrated the short (1 year), and long-term (2 years), and extended long term (5 years) benefits of triangle tilt surgery in OBPI patients (age between 0.9 and 17 year old) by examination of their radiological reports as well as the modified Mallet functional scale [42,44,[57][58][59][60][61][62][63][64][65][66]. In addition, triangle tilt surgery is a salvage procedure in failed humeral osteotomy patients [58,65].…”