title: Biceps Tendon Lengthening Surgery for Failed Serial Casting Patients With Elbow Flexion Contractures Following Brachial Plexus Birth Injury.
abstract: OBJECTIVE
  Assessment of surgical outcomes of biceps tendon lengthening (BTL) surgery in obstetric brachial plexus injury (OBPI) patients with elbow flexion contractures, who had unsuccessful serial casting.
  
  
  BACKGROUND
  Serial casting and splinting have been shown to be effective in correcting elbow flexion contractures in OBPI. However, the possibilities of radial head dislocations and other complications have been reported in serial casting and splinting. Literature indicates surgical intervention when such nonoperative techniques and range-of-motion exercises fail. Here, we demonstrated a significant reduction of the contractures of the affected elbow and improvement in arm length to more normal after BTL in these patients, who had unsuccessful serial casting.
  
  
  METHODS
  Ten OBPI patients (6 girls and 4 boys) with an average age of 11.2 years (4-17.7 years) had BTL surgery after unsuccessful serial casting.
  
  
  RESULTS
  Mean elbow flexion contracture was 40° before and 37° (average) after serial casting. Mean elbow flexion contracture was reduced to 8° (0°-20°) post-BTL surgical procedure with an average follow-up of 11 months. This was 75% improvement and statistically significant (P < .001) when compared to 7% insignificant (P = .08) improvement after serial casting.
  
  
  CONCLUSIONS
  These OBPI patients in our study had 75% significant reduction in elbow flexion contractures and achieved an improved and more normal length of the affected arm after the BTL surgery when compared to only 7% insignificant reduction and no improvement in arm length after serial casting.
authors.affiliation: Texas Nerve and Paralysis Institute, Fannin St, Houston, TX 77030.
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Nath
authors.affiliation: Texas Nerve and Paralysis Institute, Fannin St, Houston, TX 77030.
authors.forename: Chandra
authors.initials: C
authors.lastname: Somasundaram
keywords: biceps tendon lengthening; elbow flexion contracture; limb length discrepancy; obstetric brachial plexus injury; serial casting