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Glenoid osteotomy with various tendon transfers for brachial plexus birth palsy: clinical outcomes
Ramin Zargarbashi1, Hamid Rabie2, Behnam Panjavi1
1Pediatric Orthopaedic Surgery, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.
Insights
This study shows that surgical treatment combining open reduction, glenoid osteotomy, and tendon transfer significantly improves shoulder function in children with brachial plexus birth injury (BPBI) and posterior dislocation. Outcomes were assessed using the Mallet score, demonstrating functional gains.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Posterior shoulder dislocation is a disabling complication of brachial plexus birth injury (BPBI).
- Current treatments include open reduction, osteotomy, and tendon transfers, but outcomes need further evaluation.
Purpose of the Study:
- To evaluate the clinical outcomes of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy in BPBI patients with posterior shoulder dislocation or subluxation.
Main Methods:
- A cohort of 33 patients with BPBI and posterior shoulder dislocation/subluxation underwent open reduction, glenoid osteotomy, and tendon transfer between 2018-2020.
- Patients were classified using the Waters radiographic classification and functionally assessed with the Mallet grading system pre- and post-operatively (minimum 2 years follow-up).
Main Results:
- Significant improvements were observed in the overall Mallet score and specific functional segments (hand-to-mouth, hand-to-neck, global abduction, external rotation, ROM).
- Hand-to-back score and Trumpet sign presence significantly decreased post-surgery (P < .001) in both infantile and noninfantile dislocations.
Conclusions:
- Open reduction with glenoid osteotomy effectively addresses glenohumeral deformity and retroversion in BPBI.
- Muscle strengthening via tendon transfers is a viable and effective surgical strategy for managing posterior shoulder dislocation in BPBI.
Background:
Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy in patients with BPBI and posterior shoulder dislocation or subluxation.
Methods:
From 2018 to 2020, 33 patients who underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least 2 years after the surgery.
Results:
The patients were monitored for 26.88 ± 5.47 months. Their average age was 27.5 ± 14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments including hand-to-mouth, hand-to-neck, global abduction, global external rotation, abduction range of motion (ROM), and external rotation ROM. Hand-to-back score and the presence of a Trumpet sign were significantly decreased in the postoperation phase (all P values < .001). The above-mentioned variables significantly changed for both infantile and noninfantile dislocations.
Conclusion:
Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.
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