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Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric
Atakan Aydın1, Ahmet Biçer, Türker Özkan
1Istanbul University, Istanbul Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, Capa, Istanbul.
Insights
Tendon transfers effectively improve shoulder function in children with obstetrical brachial plexus palsy. Previous nerve surgery did not significantly impact outcomes for total paralysis cases, showing satisfactory shoulder abduction is achievable.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Reconstructive Surgery
Background:
- Obstetrical brachial plexus palsy (OBPP) management involves early nerve repair or late reconstructive procedures.
- Tendon transfers are primary for late reconstruction of residual deformities.
- This study investigates the impact of prior nerve surgery on outcomes of tendon transfers for shoulder dysfunction in OBPP.
Purpose of the Study:
- To compare the efficacy of tendon transfers for shoulder dysfunction in OBPP patients with and without prior early nerve surgery.
- To evaluate the influence of previous neural interventions on functional recovery after palliative surgery.
Main Methods:
- Retrospective analysis of 91 OBPP patients undergoing latissimus dorsi/teres major to humerus tendon transfer (2002-2009).
- Comparison of preoperative and postoperative active range of motion (ROM) for shoulder abduction and external rotation.
- Stratification of patients based on history of neural surgery during infancy.
Main Results:
- Early surgery groups showed significant improvement in external rotation (25° total, 75° upper palsy).
- Palliative surgery-only groups had no significant pre- to postoperative ROM changes.
- Preoperative ROM differences between early and palliative groups for total palsy diminished postoperatively for abduction, but not external rotation.
Conclusions:
- Tendon transfers can achieve satisfactory shoulder abduction in total paralysis cases, irrespective of prior nerve surgery history.
- Outcomes suggest that tendon transfers are a viable option for residual shoulder deficits in OBPP, even with varying preoperative conditions.
Background:
The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.
Methods:
A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.
Results:
In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.
Conclusions:
In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.
