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Galbiatti JA, Cardoso FL, Galbiatti MGP. Answer to the Letter to the Editor Regarding the Article "Obstetric Paralysis: Who is to Blame? A Systematic Literature Review". Rev Bras Ortop 2021; 56:405-406. [PMID: 34239212 PMCID: PMC8249097 DOI: 10.1055/s-0040-1722592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Antonio Galbiatti
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Marília, Marília, SP, Brasil
| | - Fabrício Luz Cardoso
- Disciplina de Anatomia Humana, Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brasil
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Bénié CA, Akobé JRA, Lohourou FG, Traoré I, Kpangni JBA, Kouassi NAA, Bamba I. [Obstetrical brachial plexus palsy (PBOPP): epidemiological, therapeutic and evolutionary features of patients at the Bouaké University Hospital, Ivory Coast]. Pan Afr Med J 2021; 38:309. [PMID: 34178227 PMCID: PMC8197050 DOI: 10.11604/pamj.2021.38.309.22940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 02/06/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction la paralysie obstétricale du plexus brachial est une affection relativement rare mais qui n´a pas disparu malgré les importants progrès en obstétrique. L´objectif de cette étude était de décrire les aspects épidémiologiques, thérapeutiques et évolutifs de cette affection dans notre contexte. Méthodes analyse rétrospective sur deux ans des dossiers de nouveau-nés ayant présenté une paralysie obstétricale du plexus brachial et pris en charge au Centre Hospitalier Universitaire de Bouaké. Les enfants reçus après l´âge de 3 mois n´ont pas été inclus. Les variables étudiées étaient d´ordre épidémiologique, thérapeutique et évolutif. Résultats soixante patients ont été colligés, soit une fréquence de 28,5%. Il y avait 31 (52%) filles. L´âge moyen était de 8 jours [J0 et J35]. Les mères étaient multipares dans 94% des cas. L´accouchement a eu lieu dans un centre de santé dans 97% des cas. Tous les enfants étaient nés à terme avec 57 (95%) présentations céphaliques. L´accouchement était eutocique dans 74% des cas. Le poids moyen de naissance était de 3604g [2150g et 4500g]. Il y avait 47 cas (78%) de paralysie C5-C6. L´immobilisation coude au corps associée à la rééducation a été réalisée chez 51 enfants (85%). La rééducation a été réalisée immédiatement chez 9 enfants (15%). La récupération fonctionnelle du membre lésé a été complète chez 50 enfants (83%) après un recul de 6 mois. Conclusion la paralysie obstétricale du plexus brachial demeure une affection obstétricale d´actualité. Son traitement conservateur, seule alternative dans notre contexte donne de bons résultats.
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Affiliation(s)
- Célestin Adoubs Bénié
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Jean Régis Achié Akobé
- Service d´Orthopédie Traumatologie du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Franck Grah Lohourou
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Ibrahim Traoré
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | | | | | - Inza Bamba
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
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Galbiatti JA, Cardoso FL, Galbiatti MGP. Obstetric Paralysis: Who is to blame? A systematic literature review. Rev Bras Ortop 2020; 55:139-146. [PMID: 32346188 PMCID: PMC7186075 DOI: 10.1055/s-0039-1698800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/06/2018] [Indexed: 12/01/2022] Open
Abstract
Obstetric palsy is classically defined as the brachial plexus injury due to shoulder dystocia or to maneuvers performed on difficult childbirths. In the last 2 decades, several studies have shown that half of the cases of Obstetric palsy are not associated with shoulder dystocia and have raised other possible etiologies for Obstetric palsy. The purpose of the present study is to collect data from literature reviews, classic articles, sentries, and evidence-based medicine to better understand the events involved in the occurrence of Obstetric palsy. A literature review was conducted in the search engine PubMed (MeSH - Medical Subject Headings) with the following keywords:
shoulder dystocia
and
obstetric palsy
, completely open, boundless regarding language or date. Later, the inclusion criterion was defined as revisions. A total of 21 review articles associated with the themes described were found until March 8, 2018. Faced with the best available evidence to date, it is well-demonstrated that Obstetric palsy occurs in uncomplicated deliveries and in cesarean deliveries, and there are multiple factors that can cause it, relativizing the responsibility of obstetricians, nurses, and midwives. The present study aims to break the paradigms that associate Obstetric palsy compulsorily with shoulder dystocia, and that its occurrence necessarily implies negligence, malpractice or recklessness of the team involved.
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Affiliation(s)
- José Antonio Galbiatti
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Marília, Faculdade de Medicina de Marília, Marília, SP, Brasil
| | - Fabrício Luz Cardoso
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina de Marília, Marília, SP, Brasil
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Abstract
BACKGROUND Birth brachial plexus injury usually affects the upper trunks of the brachial plexus and can cause substantial loss of active shoulder external rotation and abduction. Due to the unbalanced rotational forces acting at the glenohumeral joint, the natural history of the condition involves progressive glenohumeral joint dysplasia with associated upper limb dysfunction. Surgical reconstruction methods have been described previously by Sever and L'Episcopo, and modified by Hoffer and Roper to release the adduction contracture and to restore external rotation and shoulder abduction. METHODS The authors describe their preferred technique for contracture release and tendon transfer to improve external rotation and shoulder abduction. Pertinent anatomy and highlights of surgical exposure are reviewed. RESULTS The senior author has utilized this technique with consistent clinical outcomes to improve shoulder function for patients with persisting nerve palsy associated with birth brachial plexus injury. A review of the literature supports utilization of this technique. CONCLUSIONS Transfer of the latissimus dorsi and teres major to the posterior rotator cuff for reanimation of shoulder abduction and external rotation deficits associated with birth brachial plexus injury is a safe and reliable technique. Careful patient selection and attention to surgical detail are critical for optimal outcomes.
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Affiliation(s)
- David M. Brogan
- Washington University in St. Louis, MO, USA
- David M. Brogan, Orthopaedic Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
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Zaami S, Busardò FP, Signore F, Felici N, Briganti V, Baglio G, Marinelli E, Fineschi V. Obstetric brachial plexus palsy: a population-based retrospective case-control study and medicolegal considerations. J Matern Fetal Neonatal Med 2017; 31:1412-1417. [PMID: 28504029 DOI: 10.1080/14767058.2017.1317737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Signore
- Department of Obstetrics and Gynecology, San Camillo Forlanini Hospital, Rome, Italy
| | - Nicola Felici
- Unit of Reconstructive Surgery of the Limbs, San Camillo Forlanini Hospital, Rome, Italy
| | - Vito Briganti
- Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Giovanni Baglio
- Migration and Poverty (NIHMP), National Institute for Health, Roma, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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Komorowski J, Andrighetti T, Benton M. Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home‐Birth Setting. J Midwifery Womens Health 2016; 62:93-100. [DOI: 10.1111/jmwh.12527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 12/20/2022]
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[DAME trial: What consequences for our clinical practice?]. ACTA ACUST UNITED AC 2016; 45:1194-1198. [PMID: 27720517 DOI: 10.1016/j.jgyn.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/02/2016] [Indexed: 11/27/2022]
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Zuckerman SL, Eli IM, Shah MN, Bradley N, Stutz CM, Park TS, Wellons JC. Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series. J Neurosurg Pediatr 2014; 14:518-26. [PMID: 25192235 DOI: 10.3171/2014.7.peds13435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Axillary nerve palsy, isolated or as part of a more complex brachial plexus injury, can have profound effects on upper-extremity function. Radial to axillary nerve neurotization is a useful technique for regaining shoulder abduction with little compromise of other neurological function. A combined experience of this procedure used in children is reviewed. METHODS A retrospective review of the authors' experience across 3 tertiary care centers with brachial plexus and peripheral nerve injury in children (younger than 18 years) revealed 7 cases involving patients with axillary nerve injury as part of an overall brachial plexus injury with persistent shoulder abduction deficits. Two surgical approaches to the region were used. RESULTS Four infants (ages 0.6, 0.8, 0.8, and 0.6 years) and 3 older children (ages 8, 15, and 17 years) underwent surgical intervention. No patient had significant shoulder abduction past 15° preoperatively. In 3 cases, additional neurotization was performed in conjunction with the procedure of interest. Two surgical approaches were used: posterior and transaxillary. All patients displayed improvement in shoulder abduction. All were able to activate their deltoid muscle to raise their arm against gravity and 4 of 7 were able to abduct against resistance. The median duration of follow-up was 15 months (range 8 months to 5.9 years). CONCLUSIONS Radial to axillary nerve neurotization improved shoulder abduction in this series of patients treated at 3 institutions. While rarely used in children, this neurotization procedure is an excellent option to restore deltoid function in children with brachial plexus injury due to birth or accidental trauma.
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Obstetric brachial plexus palsy: the mallet grading system for shoulder function--revisited. BIOMED RESEARCH INTERNATIONAL 2014; 2014:398121. [PMID: 24527447 PMCID: PMC3909974 DOI: 10.1155/2014/398121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/27/2013] [Accepted: 12/28/2013] [Indexed: 11/26/2022]
Abstract
The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The aim of the current study is to investigate the percentage of children in which the Mallet score could not be applied because of a discrepancy between the deficiency of shoulder abduction and shoulder external rotation. The study group included 50 consecutive unoperated older children (over 5 years of age) with Erb's palsy and deficits in shoulder movements. The Mallet score could be applied in 40 cases (80%). In the remaining 10 cases (20%), the Mallet score could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n = 7) or vice versa (n = 3). It was concluded that documenting the deficits in shoulder abduction and external rotation are best done separately and this can be accomplished by using other grading systems.
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Abstract
Any delivery in the emergency department is considered a precipitous birth and is an anxiety-producing event. Many deliveries proceed without incident. However, the emergency physician must be prepared for several dreaded scenarios, such as nuchal cord, shoulder dystocia, and breech birth. This article reviews the basics, complications, and management of such deliveries.
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Alyanak B, Kılınçaslan A, Kutlu L, Bozkurt H, Aydın A. Psychological adjustment, maternal distress, and family functioning in children with obstetrical brachial plexus palsy. J Hand Surg Am 2013; 38:137-42. [PMID: 23218557 DOI: 10.1016/j.jhsa.2012.09.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/27/2012] [Accepted: 09/28/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine emotional and behavioral characteristics of children with obstetrical brachial plexus palsy (OBPP), psychological distress of their mothers and their family functioning, and compare them with healthy peers. METHODS Participants included 42 children with OBPP (22 boys, 20 girls; age range, 4-16 y; mean, 7 y 0 mo; SD, 3 y 3 mo) and 43 healthy controls (24 boys, 19 girls; age range, 4-15 y; mean, 8 y 0 m; SD, 3 y 0 mo). Childhood Behavior Checklist, Symptom Checklist 90, and Family Assessment Device were filled in by the mothers. RESULTS Participants with OBPP displayed higher problem scores than the comparison children in most of the domains, including internalizing and externalizing problems. Maternal distress was higher in the OBPP group, and few differences in family functioning were noted. Maternal distress and having the diagnosis of OBPP were the strongest predictors of children's total problem scores and explained 26% of the variance when the effect of age, sex, and family functioning were controlled. CONCLUSIONS Children with OBPP and their mothers are at increased risk for a variety of psychological problems. Professionals should be aware of these children's and their caregivers' psychological adjustment and refer them for further psychological support when needed. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Behiye Alyanak
- Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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Cohain JS. Suspected macrosomia: will induction of labour modify the risk of caesarean delivery? BJOG 2012; 119:1016-7; author reply 1017. [PMID: 22703425 DOI: 10.1111/j.1471-0528.2012.03326.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nath RK, Kumar N, Avila MB, Nath DK, Melcher SE, Eichhorn MG, Somasundaram C. Risk factors at birth for permanent obstetric brachial plexus injury and associated osseous deformities. ISRN PEDIATRICS 2012; 2012:307039. [PMID: 22518326 PMCID: PMC3302058 DOI: 10.5402/2012/307039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/31/2011] [Indexed: 01/23/2023]
Abstract
Purpose. To examine the most prevalent risk factors found in patients with permanent obstetric brachial plexus injury (OBPI) to identify better predictors of injury. Methods. A population-based study was performed on 241 OBPI patients who underwent surgical treatment at the Texas Nerve and Paralysis Institute. Results. Shoulder dystocia (97%) was the most prevalent risk factor. We found that 80% of the patients in this study were not macrosomic, and 43% weighed less than 4000 g at birth. The rate of instrument use was 41% , which is 4-fold higher than the 10% predicted for all vaginal deliveries in the United States. Posterior subluxation and glenoid version measurements in children with no finger movement at birth indicated a less severe shoulder deformity in comparison with those with finger movement. Conclusions. The average birth weight in this study was indistinguishable from the average birth weight reported for all brachial plexus injuries. Higher birth weight does not, therefore, affect the prognosis of brachial plexus injury. We found forceps/vacuum delivery to be an independent risk factor for OBPI, regardless of birth weight. Permanently injured patients with finger movement at birth develop more severe bony deformities of the shoulder than patients without finger movement.
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Affiliation(s)
- Rahul K Nath
- Research Division, Texas Nerve and Paralysis Institute, Houston, TX 77030, USA
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Abstract
This article reviews one of the less common but most dreaded complications of labor and delivery, shoulder dystocia, an infrequent but potentially devastating event that results from impaction of the fetal shoulders in the maternal pelvis. Shoulder dystocia occurs most commonly in patients without identified risk factors, and can result in both maternal and fetal morbidity. Because the vast majority of cases of shoulder dystocia are unpredictable, obstetric care providers must be prepared to recognize dystocia and respond appropriately in every delivery. Detailed documentation is essential after any delivery complicated by shoulder dystocia.
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