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Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP)

Tuna Pehlivanoglu1, Ali Erşen1, Serkan Bayram1

  • 1Department of Orthopaedic Surgery and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Journal of Shoulder and Elbow Surgery
|September 10, 2018
PubMed

Insights

Latissimus dorsi (LD) and teres major (TM) tendon transfers combined with internal rotation contracture release improved shoulder function in children with obstetrical brachial plexus palsy (OBPP). Arthroscopic subscapularis (SS) release showed superior outcomes compared to open pectoralis major (PM) Z-plasty.

Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Brachial plexus injury management

Background:

  • Obstetrical brachial plexus palsy (OBPP) often requires surgical intervention to improve shoulder function.
  • Latissimus dorsi (LD) and teres major (TM) tendon transfers are established procedures for shoulder abduction and external rotation.
  • Internal rotation contractures necessitate release procedures, with open pectoralis major (PM) Z-plasty and arthroscopic subscapularis (SS) release being common options.

Purpose of the Study:

  • To compare the functional outcomes of LD and TM tendon transfers when combined with either open PM tendon Z-plasty or arthroscopic SS release.
  • To evaluate the effectiveness of different surgical release techniques in enhancing outcomes for OBPP patients.

Main Methods:

  • A cohort of 24 patients with OBPP underwent LD and TM tendon transfers.
  • Patients were divided into two groups: arthroscopic SS release (9 patients) and open PM tendon Z-plasty (15 patients).
  • Functional outcomes were assessed using range of motion measurements and the Mallet scoring system, with follow-up periods ranging from 36 to 60 months.

Main Results:

  • Both surgical approaches significantly improved shoulder abduction-external rotation and Mallet scores (P < .001).
  • The arthroscopic SS release group demonstrated statistically superior postoperative abduction degrees (P = .003) and total Mallet scores (P < .001).
  • Specific Mallet sub-scores, including superior abduction, active external rotation, hand-to-head, and hand-to-mouth, were significantly better in the arthroscopic SS release group.

Conclusions:

  • LD and TM tendon transfers combined with internal rotation contracture release provide significant clinical and functional benefits for OBPP patients under age 7.
  • Arthroscopic SS release, while demanding surgical expertise, offers superior functional outcomes and is considered a less invasive approach compared to open PM Z-plasty.
  • The choice of release method can impact the degree of functional improvement following tendon transfers for OBPP.
Abstract

Keywords:
Mallet scoreObstetrical brachial plexus palsyarthroscopic SS releaseinternal rotation contracturelatissimus dorsi and pectoralis major tendon transfersopen pectoralis major tendon Z-plastyrelease procedures

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