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Obstetric Paralysis: Evaluation of the Sever-L'Episcopo Technique Modified by Hoffer
Antonio L Severo1, Pedro G L Carvalho1, Marcelo B Lemos1
1Departamento do Instituto de Ortopedia e Traumatologia, Universidade Federal da Fronteira Sul, Campus do Hospital São Vicente de Paulo, Passo Fundo, RS, Brasil.
Insights
Hoffer
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
Background:
- High obstetric paralysis, characterized by shoulder adduction and internal rotation contractures, often requires surgical intervention.
- The Sever-L'Episcopo technique, modified by Hoffer, addresses sequelae without secondary bone deformities.
Purpose of the Study:
- To evaluate the efficacy of the modified Sever-L'Episcopo (Hoffer) technique in treating high obstetric paralysis.
- To assess functional outcomes, specifically abduction and external rotation, in pediatric patients.
Main Methods:
- A series of 28 pediatric cases with high obstetric paralysis (Mallet class II) were treated.
- Procedures included pectoralis major lengthening, subscapularis tenotomy, and latissimus dorsi/teres major transfer to the infraspinatus.
Main Results:
- 24 out of 28 patients achieved excellent functional scores (Mallet class IV), significantly improving abduction and external rotation.
- Four patients improved to Mallet class III, with some residual global movement limitation.
- All patients demonstrated improved ability to perform previously difficult daily tasks.
Conclusions:
- The modified Sever-L'Episcopo (Hoffer) surgical technique is effective for treating high obstetric paralysis sequelae.
- The procedure enhances shoulder function, particularly abduction and external rotation, in children without secondary bone deformities.
Abstract:
Evaluate the results of a series of 28 cases of high obstetric paralysis treated with the Sever-L'Episcopo technique modified by Hoffer, between 2003 and 2016. Children (mean age, four years and seven months) with adduction contracture and internal rotation of the shoulder without secondary bone deformities (Mallet class II) underwent lengthening of the pectoralis major muscle and tenotomy of the subscapularis muscle associated with transfer of the latissimus dorsi and teres major muscle to the infraspinatus muscle, moving to the function of external rotators and elevators. The mean follow-up was three years and 10 months. At the end of the study, 24 patients achieved excellent functional assessment scores, mainly of the abduction and external rotation, passing from Mallet class II to class IV. Four patients still demonstrated some degree of global movement limitation, passing from class II to class III. Regardless of the final functional gain, all patients were able to perform tasks that were previously difficult. The data from this study suggest that Hoffer's surgery is an effective method in the treatment of the sequelae of high obstetric paralysis without secondary bone deformities.
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