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Triangle tilt surgery in an older pediatric patient with obstetric brachial plexus injury
Rahul K Nath1, Abdelouahed Amrani, Sonya E Melcher
1Texas Nerve and Paralysis Institute, Houston, TX 77030, USA. drnath@drnathmedical.com
Insights
The triangle tilt surgery effectively treated glenohumeral joint deformity in an older child with obstetric brachial plexus injury. This procedure improved shoulder function and reduced humeral head subluxation, offering hope for similar cases.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Surgical Innovation
Background:
- Obstetric brachial plexus injury can cause long-term impairment, including muscle and bone deformities.
- Humeral head subluxation is a challenging complication in older pediatric patients.
- The triangle tilt procedure has shown benefits in younger children.
Purpose of the Study:
- To evaluate the effectiveness of the triangle tilt procedure in an older pediatric patient with residual obstetric brachial plexus injury.
- To assess the impact of the surgery on glenohumeral joint deformity and humeral head subluxation.
- To determine if the triangle tilt procedure can be applied to older children without modification.
Main Methods:
- Case report of a 12-year-old patient with left-sided residual obstetric brachial plexus injury.
- Surgical intervention using the triangle tilt procedure.
- Clinical assessment of glenohumeral joint dysplasia, humeral head subluxation, and shoulder function (Mallet score) pre- and post-surgery.
Main Results:
- The patient showed significant clinical improvement 2 years after surgery.
- Improvements were noted in glenohumeral joint dysplasia and reduction of humeral head subluxation.
- Functional improvement was observed 25 months post-surgery, with the Mallet score increasing from 14 to 20.
Conclusions:
- The triangle tilt procedure is effective for treating glenohumeral joint deformity in older pediatric patients with obstetric brachial plexus injury.
- This case demonstrates the procedure's applicability without modification in this age group.
- Further research is needed to confirm long-term outcomes in older pediatric populations.
Abstract:
Children with an obstetric brachial plexus injury have an elevated risk of long-term impairment if they do not fully recover by the age of 3 months. Persistent nerve damage leads to muscle abnormalities and progressive muscle and bone deformities. Several procedures have been described to treat this severe deformity. We have demonstrated the benefits of the triangle tilt procedure in young children with a mean age of 6.4 years (2.2 to 10.3), yet the treatment of humeral head subluxation secondary to obstetric brachial plexus injury represents a challenge in older pediatric patients. This case report demonstrates the effectiveness of triangle tilt surgery for the treatment of glenohumeral joint deformity in a 12 year old pediatric patient with left sided residual brachial plexus injury. The patient in this study showed noticeable clinical improvements, an improvement in glenohumeral joint dysplasia, and a reduction in humeral head subluxation 2 years after triangle tilt surgery. There was functional improvement 25 months after surgery. The patient's total Mallet score for shoulder function improved from 14 to 20 (of 25). In this case report, we demonstrate that the triangle tilt procedure can be used for older pediatric patients without modification. This observation has provided valuable information and is, to our knowledge, the first documented improvement of a glenohumeral joint deformity in an older pediatric patient. Future studies will be needed to determine the long-term success of triangle tilt surgery in this age group.
