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

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.

Outcome of secondary shoulder surgery in children with neonatal brachial plexus palsy with and without nerve surgery treatment history: A long-term follow-up study

“…In contrast to the current study, most other studies regarding the outcome of secondary shoulder surgery in children with NBPP did not take previous nerve surgery into account (21,41) or reported the outcomes for both groups as a single series (16-20, 24-30, 39, 40). Only 2 studies on the outcomes of secondary shoulder surgery described the outcomes for the 2 groups separately (22,32). One study found, similar to the current study, that those children who have had previous nerve surgery had worse ROM at baseline (32).…”

“…Only 2 studies on the outcomes of secondary shoulder surgery described the outcomes for the 2 groups separately (22,32). One study found, similar to the current study, that those children who have had previous nerve surgery had worse ROM at baseline (32). The other study only stated that improvement in ROM was greater for the group without prior nerve surgery (22), which is opposed to the findings in the current study, where improvements were similar.…”

“…The second study reported 91 patients with a tendon transfer to the shoulder, divided into 4 subgroups (upper-and total plexus lesions were analysed separately, and divided with regards to: with/without prior nerve surgery (20 vs 71 patients, respectively)). The group without prior nerve surgery had better pre-operative ROM, but outcome of surgery over time was comparable for the groups (32). Two studies only included children who have had no prior nerve surgery (20,33).…”

“…Two studies have employed subgroup analysis and reported outcomes separately for patients who have had prior nerve surgery and those who have not (22,32). One study included 67 patients (mean age 6.4 years, mean follow-up 7.5 years, 37…”

Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela

“…Obstetric brachial plexus palsy (OBPP), as one of the most dramatic disabilities after birth, 34,39 has a reported incidence of 0.1% to 0.4%. 10,40,43 Although spontaneous recovery was noted in 50% to 92% 3,24,38,40 of cases, a high risk of longterm morbidity was underlined in patients without recovery. 10,17,21,26,27,35,38,42 To define the problem and provide solutions, clinical and radiologic classification systems have been identified.…”