title: Morphometric analysis of the association of primary shoulder reconstruction procedures with scapular growth in obstetric brachial plexus paralysis patients.
abstract: BACKGROUND
  Obstetric brachial plexus paralysis (OBPP) has been associated with shoulder deformities, scapular growth, and shoulder function impairment. The absence of balanced muscular forces acting on the scapula has been considered responsible for scapula dysplasia and impaired growth as compared with the normal side. Scapula growth impairment may also lead to shoulder and upper extremity dysfunction. This study aims at showing the association of primary nerve reconstruction with the restoration of scapular bone growth potential.
  
  
  METHODS
  This is a retrospective review of 73 patients with OBPP who underwent primary shoulder reconstruction. Patients were categorized for assessment and analysis into group A, global paralysis; group B, Erb's palsy; and group C, Erb's palsy with C7 root involvement. Scapular posteroanterior and lateral X-rays were obtained in which four scapula dimensions were manually measured. The growth discrepancy depending on the applied treatment was investigated.
  
  
  RESULTS
  The highest improvement was noted in scapular height in the Erb's palsy group who underwent simultaneous neurotization of the suprascapular and axillary nerves. The oblique axis was more improved in the Erb's palsy group while both big and small widths were more improved in the Erb's palsy with C7 root involvement group in patients who underwent concomitant neurotization of the suprascapular and the axillary nerves. Functional improvement correlated positively with growth improvement in all groups and scapular dimensions.
  
  
  CONCLUSIONS
  Scapula growth and shoulder function improvement were higher in patients with Erb's palsy. Simultaneous axillary and suprascapular nerve neurotization provided the best outcome in both functional and growth restoration.
authors.affiliation: International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave., Long Island City, NY 11101 USA ; Department of Plastic Surgery, New York University Medical Center, Long Island City, NY 11101 USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Terzis
authors.affiliation: International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave., Long Island City, NY 11101 USA.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karypidis
authors.affiliation: International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave., Long Island City, NY 11101 USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mendoza
authors.affiliation: First Department of Orthopaedics, Athens University School of Medicine, "Attikon" University Hospital, 1 Rimini, 12462, Chaidari, Athens, 12462 Greece.
authors.forename: Zinon T
authors.initials: ZT
authors.lastname: Kokkalis
authors.affiliation: Mathematics and Statistics Department, Old Dominion University, 4700 Elkhorn Ave, Norfolk, VA 23529 USA.
authors.forename: Norou
authors.initials: N
authors.lastname: Diawara
keywords: Bone growth; Obstetric brachial plexus paralysis; Primary plexus reconstruction; Scapula; Shoulder