Long-term outcomes of triangle tilt surgery for obstetric brachial plexus injury.
OBJECTIVE
The purpose of this study was to evaluate long-term shoulder functional outcomes from a triangle tilt procedure on obstetric patients, who initially presented with medial rotation contracture and scapular deformity secondary to obstetric brachial plexus injury.


METHODS
We retrospectively studied long-term outcomes both functionally and anatomically in 61 patients (age ranging from 2 to 12 years). Functional movements were evaluated and scored using a modified Mallet scale at different time intervals: preoperatively, 1 year and 2 year following triangle tilt surgery. Shoulder anatomy was examined on radiologic images to evaluate the severity of shoulder deformities preoperatively and anatomical improvement after the surgery.


RESULTS
All shoulder functional movements were significantly improved at 1 and 2 year follow-ups. Functional improvements were maintained in shoulder abduction, external rotation and hand-to-mouth movements beyond the first year, and continued in hand-to-neck and hand-to-spine movements past 2 years. Remarkable glenohumeral remodeling or reservation of glenoid congruence was observed in all patients over a mean time of 27 months postoperatively.


CONCLUSIONS
The triangle tilt procedure, which addresses scapular and glenohumeral joint abnormalities characteristic of Erb's palsy, improves shoulder functional movements and anatomical structure in patients over the long-term.
Texas Nerve and Paralysis Institute, Houston, USA. drnath@drnathmedical.com
Rahul K
RK
Nath
Xiaomei
X
Liu
Sonya E
SE
Melcher
Jilao
J
Fan
D001720:Birth Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome