'Switch' technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy

Area of Science:

• Pediatric Orthopedics
• Hand Surgery
• Neuromuscular Disorders

Background:

• Brachial plexus birth palsy (BPBP) often results in significant upper limb deformities, including supination and ulnar deviation.
• These deformities can severely impact a child's functional independence and quality of life.
• Restoring active forearm rotation and hand function is a key goal in managing BPBP.

Purpose of the Study:

• To evaluate the effectiveness of specific tendon transfers in correcting supination and ulnar deviation deformities in children with BPBP.
• To assess the functional outcomes and patient satisfaction following these surgical interventions.

Main Methods:

• A retrospective case series of 17 children with BPBP who underwent extensor carpi ulnaris to brachioradialis and brachioradialis to abductor pollicis longus tendon transfers.
• Data collected included patient age at surgery, follow-up duration, and pre- and post-operative functional assessments using the Canadian Occupational Performance Measure (COPM).

Main Results:

• Patients showed marked improvements in active forearm rotation post-surgery.
• Significant increases were observed in both activity performance (1.1 to 6.7) and satisfaction (0.8 to 8.7) scores on the COPM.
• Mean age at surgery was 8.7 years, with a mean follow-up of 21 months.

Conclusions:

• The described tendon transfer procedures are effective in correcting supination and ulnar deviation deformities in pediatric patients with brachial plexus birth palsy.
• These surgical interventions lead to substantial functional gains and improved patient satisfaction.
• The findings support the use of these tendon transfers as a viable treatment option for specific BPBP-related upper limb deformities.