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Comparing functional outcome of triangle tilt surgery performed before versus after two years of age
Rahul K Nath1, Chandra Somasundaram, Faiz Mahmooduddin
1Texas Nerve and Paralysis Institute, 6400 Fannin Street, Suite 2420, Houston, TX 77030, USA.
Insights
Triangle tilt surgery for obstetric brachial plexus injuries shows better outcomes when performed before age 2. Early intervention in pediatric patients optimizes shoulder joint function and bony deformity correction.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Nerve injury management
Background:
- Obstetric brachial plexus injuries (OBPI) frequently lead to secondary shoulder joint bony deformities.
- These deformities impact functional recovery in affected children.
- Triangle tilt surgery is a recognized intervention for correcting these deformities.
Purpose of the Study:
- To compare the outcomes of triangle tilt surgery in children with OBPI based on age at operation.
- To determine if operating before or after 2 years of age influences surgical success.
Main Methods:
- A retrospective study of 36 patients with OBPI-related shoulder deformities.
- Patients were divided into two groups: Group 1 (< 2 years old, n=16) and Group 2 (> 2 years old, n=20).
- Surgical outcomes were assessed by comparing pre- and post-operative Mallet score, external rotation, hand-to-mouth function, and supination angle.
Main Results:
- Significant differences in functional outcome improvements were observed between the two age groups.
- Patients operated on before 2 years showed greater improvements in Mallet score, external rotation, hand-to-mouth function, and supination angle.
- While earlier surgery yielded superior results, improvement was still noted in the older group.
Conclusions:
- Triangle tilt surgery is more effective for improving clinical function in OBPI patients when performed before the age of 2 years.
- Younger age at surgery may allow for greater anatomical remodeling, leading to enhanced functional gains.
- Delayed surgery (after 2 years) can still lead to functional improvement, but potentially to a lesser extent.
Background:
Many patients each year who are born with obstetric brachial plexus injuries eventually do not achieve complete recovery. As a result of the primary nerve injuries, these patients will often develop bony deformities involving the shoulder joint as a secondary consequence. The triangle tilt surgery has been shown to be an effective procedure to correct these deformities and has been performed on patients ranging in age from less than a year old to adolescence. The purpose of this retrospective study is to compare outcomes of triangle tilt surgery performed on patients before the age of 2 years versus after 2 years of age to determine an optimal age to operate on these children.
Methods:
36 patients with deformities developed secondarily from the initial obstetric brachial plexus injury in this study were divided into 2 groups. Group 1, those who had undergone triangle tilt surgery at < 2 yrs of age (16 patients). Group 2, those who were operated at > 2 yrs of age (20 patients). Group 1 age range: 9 months to 23 months, average: 18 months. Group 2 age range: 26 months to 9 years, average: 6 years.
Results:
Significant differences were found between the 2 groups (0-2 yrs vs > 2yrs) in regards to overall changes (pre- to post-op) in Mallet score, external rotation score, hand-to-mouth score, and supination angle.
Discussion:
This study demonstrates that triangle tilt surgery had better outcomes on clinical functioning if performed before the age of 2 years, however, improvement in clinical functioning can still be achieved if the triangle tilt surgery is performed after the age of 2 years as well. A possible mechanism to explain this phenomenon is the increased potential for anatomical remodeling if the triangle tilt surgery is performed at a younger age, thereby leading to significant functional improvement.
