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Surgical Treatment of Infantile Shoulder Dislocation Following Brachial Plexus Birth Injury
Tamara Al Muhtaseb1, Stephanie Lamer1, Allison Allgier2
1Divisions of Orthopaedic Surgery.
Insights
Surgical treatment for infantile shoulder dislocation due to brachial plexus birth injury (BPBI) can improve shoulder function. Including external rotation tendon transfers in the initial surgery reduces the need for reoperation.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Surgical Outcomes Research
Background:
- Glenohumeral dysplasia in brachial plexus birth injury (BPBI) can lead to infantile shoulder dislocation.
- Nonoperative treatments for early dislocations are often unsuccessful, necessitating surgical intervention.
- Surgical outcomes for infantile shoulder dislocation secondary to BPBI are not well-documented.
Purpose of the Study:
- To retrospectively review the outcomes of surgical treatment for glenohumeral dislocation in infants (<1 year) with BPBI.
- To evaluate the effectiveness of different surgical techniques, including external rotation tendon transfer (ERTT).
- To identify factors influencing reoperation rates and functional outcomes.
Main Methods:
- Retrospective review of medical records for 32 patients surgically treated for shoulder dislocation at ages 5 months to <1 year.
- Dislocation defined by MRI (PHHA <10%) or ultrasound.
- Primary outcome: reoperation. Secondary outcomes: Mallet scores, passive/active external rotation, PHHA, and glenoid version.
Main Results:
- 25 patients underwent release and ERTT, with 12.0% requiring reoperation; 7 patients underwent release alone, with 85.7% requiring reoperation.
- Significant improvements in passive and active external rotation and global Mallet scores were observed.
- Reoperations were primarily for recurrent contracture, redislocation, or persistent weakness.
Conclusions:
- Surgical management of infantile shoulder dislocation in BPBI can enhance glenohumeral alignment and shoulder function.
- Incorporating ERTT in the index procedure decreases reoperation risk.
- Surgical techniques, including partial subscapularis release, can preserve internal rotation function.
Background:
Glenohumeral dysplasia following brachial plexus birth injury (BPBI) can present as dislocation of the glenohumeral joint in infancy. Multiple nonoperative treatment strategies have been reported for these early dislocations, yet none are universally successful; thus, surgical treatment may be required. However, reports of surgical treatment in infancy are scarce. The present study retrospectively reviews the outcomes of patients with BPBI treated surgically for glenohumeral dislocation under 1 year of age.
Methods:
Medical records were retrospectively reviewed for patients treated surgically for glenohumeral dislocation under 1 year of age. Dislocation was defined on magnetic resonance imaging (MRI) as a percentage of the humeral head anterior to the scapular line (PHHA) <10%, or on ultrasound, as the humeral head ossific nucleus entirely posterior to the posterior scapular line. The primary outcome was defined as the need for reoperation. Additional outcomes included Mallet scores for global shoulder function and PHHA and glenoid version measurements on follow-up MRI. Patients with <1 year follow-up were excluded.
Results:
Thirty-two patients underwent surgical intervention for shoulder dislocation at ages 5 months to <1 year with average follow-up of 4.6 years. Of these 32 patients, 25 underwent internal rotation contracture release and external rotation tendon transfer (ERTT), with 3 (12.0%) requiring revision surgery; 7 underwent release alone, with 6 (85.7%) requiring revision surgery. Across all groups, patients ultimately had improved passive and active external rotation (20.0 to 80.0 degrees, -90.0 to 30.0 degrees, respectively, P <0.0001) and global Mallet scores (14.5/30 to 19.5/30, P <0.001) without worsened internal rotation function. The indications for requiring further surgical intervention for the 9 patients were recurrent IR contracture, redislocation, persistent ER weakness, and weak abduction.
Conclusions:
Surgical treatment of infantile shoulder dislocation following BPBI can improve glenohumeral alignment and global shoulder function. The inclusion of external rotation tendon transfers at the index procedure lowers the risk of reoperation, whereas not sacrificing internal rotation function when combined with partial subscapularis release.
Level Of Evidence:
Level IV.
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