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Muscle transfer for shoulder reconstruction in obstetrical brachial plexus lesions
1Hand and Microsurgery Center, Cairo University, Cairo, Egypt. ysafoury@hotmail.com
Insights
The Hoffer technique effectively reconstructs shoulder internal rotation contractures in obstetrical brachial plexus lesions (OBPL). This surgical approach offers a safe and reliable solution, significantly improving patient shoulder function.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Neurosurgery
Background:
- Obstetrical brachial plexus lesions (OBPL) can cause significant functional deficits, including shoulder internal rotation contractures.
- These contractures impact deltoid function and external rotation, requiring surgical intervention for improvement.
Purpose of the Study:
- To evaluate the efficacy and safety of the Hoffer technique for shoulder reconstruction in pediatric patients with OBPL.
- To assess functional outcomes and complication rates following this surgical procedure.
Main Methods:
- A prospective study included 32 consecutive OBPL patients (2.3-7 years old) with internal rotation contractures.
- The Hoffer technique involved transferring latissimus dorsi and teres major muscles to the posterior rotator cuff via a transaxillary approach.
- Preoperative assessment used the modified Gilbert shoulder grading system (all patients Grade 1-2).
Main Results:
- All 32 patients demonstrated improvement, with shoulder function grading from 1-2 preoperatively to 4-5 postoperatively.
- The follow-up period ranged from 1.5 to 3.5 years (mean 2.3 years).
- Minimal recurrence of internal rotation occurred in six patients, requiring no further intervention.
Conclusions:
- The Hoffer technique is a reliable and safe surgical option for shoulder reconstruction in OBPL.
- This muscle transfer procedure leads to significant functional improvement in affected children.
- The technique demonstrates a low complication rate, supporting its clinical utility.
Abstract:
A prospective study was performed on a group of 32 consecutive obstetrical brachial plexus lesions (OBPL). Seventeen were girls and 15 were boys with an age ranging between 2.3 years to 7 years (mean 3.5 years). Patients were treated operatively for a functionally disturbing unilateral internal rotation contracture of the shoulder with a good deltoid function (grade IotaIota or greater) and no significant active external rotation. The Hoffer technique of muscle transfer in the form of transferring the latissimus dorsi and teres major muscles to the rotator cuff posteriorly through a transaxillary approach with or without subscapularis muscle release was used in all cases. Preoperatively the patients were assessed clinically according to the modified Gilbert shoulder grading system. All patients were of grade 1 and 2. Eighteen patients had a lesion of the superior trunk of the brachial plexus (C5 and C6 roots) and ten patients had various degrees of involvement of the entire plexus while in four patients previous microsurgery reconstruction was performed. All patients improved to grade 4 and 5. The follow-up period ranged from 1.5 to 3.5 years (mean 2.3 years). There were no significant complications except for recurrence of minimal internal rotation in six patients that required no further surgery. Our results suggest that the Hoffer technique for shoulder reconstruction in OBPL is a reliable and safe technique.
