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Glenohumeral dysplasia changes after tendon transfer surgery in children with birth brachial plexus injuries
Ann Van Heest1, Colleen Glisson, Hanley Ma
1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA. vanhe003@umn.edu
Insights
Children with brachial plexus birth injuries who underwent tendon transfer surgery before age 2 showed significant radiographic improvement in glenohumeral dysplasia compared to older children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Brachial plexus injury management
Background:
- Glenohumeral dysplasia is a common complication of birth brachial plexopathy.
- Early intervention is hypothesized to improve radiographic outcomes.
Purpose of the Study:
- To evaluate the effect of age at surgery on radiographic improvement in children with glenohumeral dysplasia secondary to birth brachial plexopathy treated with tendon transfer.
- To compare outcomes between children treated before and after 2 years of age.
Main Methods:
- Retrospective review of 26 children treated with latissimus dorsi and teres major tendon transfer.
- Preoperative and 1-year postoperative CT scans analyzed for glenoid version and percent humeral head anterior (PHHA).
- Comparison of radiographic measurements between two age groups: ≤24 months and >24 months at surgery.
Main Results:
- Children operated on ≤24 months showed significant improvement in PHHA and glenoid version.
- Shoulder positioning improved from dislocated/subluxed to normal in the younger group postoperatively.
- Children operated on >2 years showed minimal radiographic improvement.
Conclusions:
- Tendon transfer surgery before 2 years of age leads to significantly greater radiographic improvement in glenohumeral dysplasia.
- Age at surgery is a critical factor for successful outcomes in managing brachial plexus birth injury-related dysplasia.
- Early surgical intervention is recommended for optimal glenohumeral development.
Background:
This study hypothesizes that children with glenohumeral dysplasia secondary to birth brachial plexopathy treated with tendon transfer surgery at a younger age will show greater radiographic improvement than those treated at an older age.
Methods:
Twenty-six children treated with latissimus dorsi and teres major tendon transfer had preoperative and 1 year postoperative computed tomography (CT) scans at an average follow-up of 17 months (10 to 46 mo). Average age at surgery was 44 months (10 to 134 mo). CT scans were measured for glenoid version and percent humeral head anterior to the midscapular line (PHHA). Shoulders were classified as dislocated (PHHA 0%), subluxed (PHHA 1% to 35%), or normal positioning (>35%). Two age groups were compared: 24 months or less at the time of surgery (n=11); and greater than 2 years (n=15). Concomitant surgical techniques were also evaluated.
Results:
For the 11 children treated at 24 months of age or less, PHHA averaged 13% preoperatively (range: 0% to 54%) and postoperatively 42% (range: 25% to 51%); glenoid version averaged -25 degrees preoperatively (range: -36 to -11 degrees) and postoperatively -14 degrees (range: -31 to -2 degrees); and preoperatively 5 shoulders were dislocated, 5 subluxed, and 1 normal; whereas postoperatively 0 shoulders were dislocated, 2 subluxed, and 9 normally positioned. For the 15 children treated at greater than 2 years of age, PHHA averaged 30% preoperatively (range: 0% to 53%) and postoperatively 33% (range: 0% to 57%); glenoid version averaged -17 degrees preoperatively (range: -27 to -4 degrees) and postoperatively -16 degrees (range: -31 to -2 degrees); and preoperatively 2 shoulders were dislocated, 6 subluxed, and 7 normal; whereas postoperatively 2 shoulders were dislocated, 5 subluxed, and 8 normally positioned.
Conclusions:
Eleven children treated at 24 months of age or less had significantly greater improvement in the CT scan radiographic measurements of glenohumeral dysplasia, than the 15 children treated at greater than 2 years of age. The effect of age had greater correlation with improvement than open reduction. For children undergoing tendon transfer for lack of active external rotation due to brachial plexus birth injury, improvement in glenohumeral dysplasia can be achieved if the surgery is performed before 2 years of age.
Level Of Evidence:
Level IV, case controlled series.
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