External Rotation Osteotomy of the Humerus to Salvage the Failed Latissimus Dorsi Transfer in Children With Erb Birth Palsy and Supple Congruent Shoulders

The outcome of soft-tissue release and tendon transfer in shoulders with brachial plexus birth palsy

Background

Shoulder involvement in brachial plexus birth palsy is common, and the adduction, internal rotation contracture deformity often requires some form of surgical treatment. There are very few long-term reports on release of contracted muscles and tendon transfers, especially in older children. We are reporting the single-center results of such a surgery with detailed outcome analysis.

Methods

The prospectively collected data from brachial plexus birth palsy cases who had undergone contracture release and tendon transfer were retrospectively studied and examined. The new Mallet and functional scores were compared with the original data forms and then analyzed. The radiographic evidence of glenoid dysplasia and its correlation with age and functional outcome was assessed.

Results

A total of 82 cases with surgery at mean age of 9.5 ± 5.09 years and a follow-up of 8 ± 3.8 (3-20) years entered the study. Of these, 56% of cases had 7 to 20 years of age at surgery. Fifty-four (66%) patients had only shoulder surgery, and 28 (34%) required additional reconstructive surgeries for hand and wrist. Moderate to severe glenohumeral dysplasia was present in 38%. The preoperative Mallet score of 10.6 ± 2.97 improved to 19.3 ± 3.39 (P < .001). Eighty-one percent of patients showed improvement in “reaching face” functions, 71% in “above head” functions, and 74% in “midline functions.” The cases with lack of improvement in midline function mostly belonged to pan-plexus injuries. Noticeable subjective and objective improvement was also observed in cases with glenohumeral dysplasia in their Mallet and functional scores (P < .001). The improvement in function and subjective satisfaction of 92% was observed irrespective of age at surgery.

Conclusion

Soft-tissue release and tendon transfer for brachial plexus birth palsy shoulder can improve function and limb appearance even in older children and young adults and even in the presence of glenohumeral dysplasia.

Early Complication of Humeral Derotational Osteotomy Surgery for Obstetric Brachial Plexus as Salvage for a Failed Tendon Transfer. Case Report

In brachial plexus injuries, external rotation in patients with a moderate to severe glenohumeral dysplasia is corrected with derotational humeral osteotomy surgery. The most frequent complications described for this procedure include keloid scar, loss of external rotation secondary to bone remodelling, loss of internal rotation, prominence of osteosynthesis, fracture distal to the plate transient ulnar paraesthesia and radial nerve palsy (1), and delayed union and non-union. Rarely, treating complications associated with derotational humeral osteotomy may require revision of osteosynthesis (2). The literature that investigates the effectiveness of derotational humeral osteotomy as a procedure to rescue dorsal infraspinatus tendon transfer is limited. This article is the first communication of a pediatric patient with an obstetric brachial plexus injury receiving a derotational osteotomy as a procedure to salvage a failed rescue Latissimus dorsi tendon transfer with a complication. This case report was performed according to the principles of the Declaration of Helsinki. Written informed consent for participation in this case report was obtained from the patient's parents.