title: Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy.
abstract: OBJECTIVE
  To compare outcomes of our revision surgical operations in obstetric brachial plexus palsy (OBPP) patients to results of conventional operative procedures at other institutions.
  
  
  METHODS
  We analyzed our OBPP data and identified 10 female and 10 male children aged 2.0 to 11.8 years (average age 6.5 years), who had prior conventional surgical therapies at other clinics. Of the 20 patients, 18 undergone triangle tilt, 2 had only mod Quad. Among 18 patients, 8 had only triangle tilt and 10 had also mod Quad as revision surgeries with us. We analyzed the anatomical improvements and functional modified Mallet statistically before and after a year post-revision operations.
  
  
  RESULTS
  Pre-revision surgery average modified Mallet score was 12.0 ± 1.5. This functional score was greatly improved to 18 ± 2.3 (P< 0.0001) at least one-year after revision surgical procedures. Radiological scores (PHHA and glenoid version) were also improved significantly to 31.9 ± 13.6 (P< 0.001), -16.3 ± 11 (P< 0.0002), at least one-year after triangle tilt procedure. Their mean pre-triangle tilt (yet after other surgeon's surgeries) PHHA, glenoid version and SHEAR were 14.6 ± 21.7, -31.6 ± 19.3 and 16.1 ± 14.7 respectively.
  
  
  CONCLUSIONS
  We demonstrate here, mod Quad and triangle tilt as successful revision surgical procedures in 20 OBPP patients, who had other surgical treatments at other clinics before presenting to us for further treatment.
authors.affiliation: Rahul K Nath, Chandra Somasundaram, Texas Nerve and Paralysis Institute, Houston, TX 77030, United States.
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Nath
authors.affiliation: Rahul K Nath, Chandra Somasundaram, Texas Nerve and Paralysis Institute, Houston, TX 77030, United States.
authors.forename: Chandra
authors.initials: C
authors.lastname: Somasundaram
keywords: Joint incongruity; Obstetric brachial plexus palsy; Revision surgery; Shoulder movements; Upper limb