Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Reconstructive Surgery

Background:

• Obstetric brachial plexus palsy (OBPP) can result in significant functional deficits.
• Previous surgical interventions at other institutions may not yield optimal outcomes.
• Revision surgery is considered for OBPP patients who have not achieved satisfactory results.

Purpose of the Study:

• To evaluate the efficacy of revision surgical procedures in OBPP patients.
• To compare outcomes of revision surgeries (mod Quad and triangle tilt) with prior conventional treatments.
• To assess anatomical and functional improvements following revision surgery for OBPP.

Main Methods:

• Retrospective analysis of 20 OBPP patients (10 male, 10 female) aged 2.0-11.8 years.
• Patients had prior conventional surgeries elsewhere and underwent revision procedures (triangle tilt and/or mod Quad).
• Functional (modified Mallet score) and radiological (PHHA, glenoid version) outcomes were assessed pre- and post-revision surgery.

Main Results:

• Significant improvement in modified Mallet scores from 12.0 ± 1.5 pre-revision to 18 ± 2.3 post-revision (P < 0.0001).
• Radiological scores showed significant improvements: PHHA to 31.9 ± 13.6 (P < 0.001) and glenoid version to -16.3 ± 11 (P < 0.0002) after triangle tilt.
• Pre-revision radiological scores indicated suboptimal joint alignment.

Conclusions:

• Mod Quad and triangle tilt are effective revision surgical procedures for OBPP.
• These revision techniques provide significant functional and anatomical benefits for OBPP patients.
• Successful outcomes were achieved in OBPP patients with prior surgical treatment history.