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Published on: December 19, 2019
The Putti Sign Following Residual Brachial Plexus Birth Injury: Prevalence and Significance
Hutanu Dragos1, Pablo Corona2, Juliana Rojas-Neira3
1George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania.
Insights
The Putti sign is common in children with brachial plexus birth injury (BPBI) and linked to glenohumeral abduction contractures. This deformity impacts function, not just appearance.
Area of Science:
- Pediatric Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- The Putti sign is a common deformity in children with brachial plexus birth injury (BPBI).
- It arises from a glenohumeral (GH) abduction contracture.
- Previous studies have not determined the prevalence of the Putti sign or its link to GH abduction contractures.
Purpose of the Study:
- To investigate the prevalence of the Putti sign in children with residual BPBI.
- To explore the correlation between the Putti sign and glenohumeral (GH) abduction contractures.
- To determine the functional impact of the Putti sign.
Main Methods:
- A prospective analysis of 238 patients with residual BPBI (ages 4.1-16.2 years) was conducted.
- Data collected included demographics, palsy levels, modified Mallet scale, surgical history, Putti sign presence, and GH adduction angle (GHADD).
- Statistical analyses included chi-square, Mann-Whitney U, Kruskal-Wallis, and ROC analysis.
Main Results:
- The Putti sign was present in 27% of patients with residual BPBI.
- A correlation was confirmed between the Putti sign and GH adduction contractures (GHADD < -5°).
- The Putti sign was associated with reduced external rotation activities, and no significant age-based prevalence differences were found.
Conclusions:
- The Putti sign is a frequent finding in children with residual BPBI.
- This sign has functional implications beyond cosmetic concerns, indicating functional impairment.
- While prevalence is similar across age groups, younger (0-5 years) and early adolescent (11-15 years) groups showed more severe contractures.
Background:
The Putti sign, a common deformity and complaint in children with brachial plexus birth injury (BPBI), stems from a glenohumeral (GH) abduction contracture. Despite recent clinical studies offering insights into this deformity, none have explored the prevalence of the Putti sign or its correlation with GH abduction contractures.
Methods:
We conducted a prospective analysis of 238 patients (median age 7.5 years; range, 4.1-16.2) with residual BPBI seen in the clinic from December 2019 to December 2022. Epidemiological data, including demographics, palsy levels, modified Mallet scale sum, surgical history, and presence/absence of the Putti sign and glenohumeral adduction angle (GHADD), were collected. Patients were categorized into 4 age groups: 0 to 5 years (n=67), 6 to 10 years (n=102), 11 to 15 years (n=53), and 16 years and older (n=16). Results were expressed as medians (minimum-maximum), with frequency comparisons done using Pearson's chi-square analysis. Mann-Whitney U and Kruskal-Wallis tests were used for quantitative variable comparison, and receiver operating characteristic (ROC) analysis determined the threshold GHADD angle for Putti sign appearance.
Results:
Main findings included: (1) 27% of patients with residual BPBI exhibited the Putti sign, (2) confirmed correlation between the Putti sign and GH adduction contractures, (3) Putti sign manifestation with GHADD angle measuring less than -5° because to abduction contracture, and (4) association between this deformity and reduced activities requiring external rotation. No significant differences in Putti sign prevalence were found across age groups.
Conclusions:
Our study underscores the common occurrence of the Putti sign in children with residual BPBI. It is important to note that we highlight its functional significance beyond cosmetic concerns. Contrary to prior literature, our analysis reveals functional impairment associated with the Putti sign. Although no age-based differences in Putti sign prevalence were observed, patients aged 0 to 5 years and 11 to 15 years showed more severe glenohumeral abduction contractures, possibly due to growth spurts.
Level Of Evidence:
Diagnosis IV.
