Primary and secondary shoulder reconstruction in obstetric brachial plexus palsy.
OBJECTIVE
In this retrospective review, the methods and outcomes in 96 children (98 extremities) with obstetric brachial plexus palsy who underwent primary reconstruction and/or palliative surgery for shoulder function were analysed.


METHODS
Thirty cases underwent primary reconstruction alone, 37 underwent both primary and secondary procedures, and 31 late cases underwent only palliative surgery. The mean follow-up period was 6.7 years.


RESULTS
The mean shoulder abduction increased from 48 degrees +/-32 degrees preoperatively to 123 degrees +/-35 degrees postoperatively (average gain 75 degrees ); the mean active external rotation with the arm at the side increased from -19 degrees +/-17 degrees to 62 degrees +/-21 degrees (mean gain 81 degrees ); and the mean aggregate Mallet score improved from 8.8 points to 20.9 points, respectively.


CONCLUSIONS
Reconstruction of both axillary and suprascapular nerves yielded improved outcomes of shoulder abduction and external rotation. Early plexus reconstruction (<or=3 months) offered the best functional results and reduced the need for secondary reconstructions. A marked improvement was observed after palliative surgery irrespective of prior nerve reconstruction. Rerouting of latissimus dorsi and/or teres major tendons, combined with extra-articular musculotendinous lengthening, significantly improved global shoulder function.
Terzis
Julia K
JK
Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, LH 2055, Norfolk, VA 23501, USA. mrc1@erols.com
Kokkalis
Zinon T
ZT
D000293:Adolescent; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008297:Male; D010166:Palliative Care / Q000379:methods; D010246:Paralysis, Obstetric / Q000150:complications / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012399:Rotation; D012785:Shoulder Joint / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult