Surgical correction of a rotational deformity of the shoulder in patients with obstetric brachial plexus palsy: Short-term results in 270 patients.
We evaluated results at one year after surgical correction of internal rotation deformities in the shoulders of 270 patients with obstetric brachial plexus palsy. The mean age at surgery was 6.2 years (0.6 to 35). Two techniques were used: open subscapularis elongation and latissimus dorsi to infraspinatus transfer. In addition, open relocation was performed or attempted in all patients with subluxed or dislocated joints. A mixed effects model approach was used to evaluate the effects of surgery on internal and external rotation, abduction, flexion and Mallet score. Independent factors included operative status (pre- or post-operative), gender, age, the condition of the joint, and whether or not transfer was performed. The overall mean improvement in external rotation following surgery was 84.6° (95% confidence interval (CI) 80.2 to 89.1) and the mean Mallet score improved by 4.0 (95% CI 3.7 to 4.2). There was a mean decrease in internal rotation of between 27.6° and 34.4° in the relocated joint groups and 8.6° (95% CI 5.2 to 12.0) in the normal joint group. Abduction and flexion were unchanged following surgery. Adding a latissimus dorsi transfer did not result in greater improvement in the mean external rotation compared with elongation of the subscapularis alone.
Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Section for Hand Surgery, S-118 83 Stockholm, Sweden.
T
T
Hultgren
K
K
Jönsson
H
H
Pettersson
H
H
Hammarberg
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001720:Birth Injuries / Q000150:complications*; D020516:Brachial Plexus Neuropathies / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012399:Rotation; D012737:Sex Factors; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Brachial plexus; Obstetric; Relocation; Rotation contracture; Shoulder; Subscapularis