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Rahul K Nath¹, Chandra Somasundaram¹

¹Texas Nerve and Paralysis Institute, Fannin St, Houston, TX 77030.

|September 21, 2016

Insights

Biceps tendon lengthening surgery significantly improved elbow flexion contractures in obstetric brachial plexus injury patients after failed serial casting. This surgical intervention led to a 75% reduction in contractures and better arm length.

Area of Science:

Orthopedic surgery
Pediatric orthopedics
Brachial plexus injury management

Background:

Serial casting is a common treatment for elbow flexion contractures in obstetric brachial plexus injury (OBPI).
Complications such as radial head dislocations can occur with serial casting.
Surgical intervention is considered when conservative methods fail.

Purpose of the Study:

To assess the surgical outcomes of biceps tendon lengthening (BTL) in OBPI patients with elbow flexion contractures.
To evaluate the effectiveness of BTL after unsuccessful serial casting.
To determine improvements in elbow contractures and arm length.

Main Methods:

Ten OBPI patients (6 girls, 4 boys) with a mean age of 11.2 years underwent BTL surgery.
Patients had a history of unsuccessful serial casting for elbow flexion contractures.
Surgical outcomes were assessed after an average follow-up of 11 months.

Main Results:

Mean elbow flexion contracture decreased from 40° to 8° post-BTL surgery, a 75% statistically significant improvement (P < .001).
Serial casting resulted in only a 7% insignificant improvement (P = .08).
BTL surgery led to improved and more normal arm length.

Conclusions:

Biceps tendon lengthening surgery is an effective treatment for elbow flexion contractures in OBPI patients who have not responded to serial casting.
BTL surgery provides a significant reduction in contractures and improves arm length.
This surgical approach offers a superior outcome compared to serial casting alone for persistent OBPI-related contractures.

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Abstract

Objective:

Assessment of surgical outcomes of biceps tendon lengthening (BTL) surgery in obstetric brachial plexus injury (OBPI) patients with elbow flexion contractures, who had unsuccessful serial casting.

Background:

Serial casting and splinting have been shown to be effective in correcting elbow flexion contractures in OBPI. However, the possibilities of radial head dislocations and other complications have been reported in serial casting and splinting. Literature indicates surgical intervention when such nonoperative techniques and range-of-motion exercises fail. Here, we demonstrated a significant reduction of the contractures of the affected elbow and improvement in arm length to more normal after BTL in these patients, who had unsuccessful serial casting.

Methods And Patients:

Ten OBPI patients (6 girls and 4 boys) with an average age of 11.2 years (4-17.7 years) had BTL surgery after unsuccessful serial casting.

Results:

Mean elbow flexion contracture was 40° before and 37° (average) after serial casting. Mean elbow flexion contracture was reduced to 8° (0°-20°) post-BTL surgical procedure with an average follow-up of 11 months. This was 75% improvement and statistically significant (P < .001) when compared to 7% insignificant (P = .08) improvement after serial casting.

Conclusion:

These OBPI patients in our study had 75% significant reduction in elbow flexion contractures and achieved an improved and more normal length of the affected arm after the BTL surgery when compared to only 7% insignificant reduction and no improvement in arm length after serial casting.

Keywords:

biceps tendon lengthening elbow flexion contracture limb length discrepancy obstetric brachial plexus injury serial casting

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