Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysisReport as inadecuate




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BMC Musculoskeletal Disorders

, 12:74

First Online: 13 April 2011Received: 17 February 2010Accepted: 13 April 2011

Abstract

BackgroundThe surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.

MethodsA total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi-teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.

ResultsIn the early surgery groups, only the postoperative external rotation angles showed statistically significant differences 25 degrees and 75 degrees for total and upper type palsies, respectively. Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively p < 0.05 and p > 0.05, respectively for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.

ConclusionsIn this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-12-74 contains supplementary material, which is available to authorized users.

Atakan Aydın, Türker Özkan, Berkan Mersa, Safiye Özkan and Zeynep Hoşbay Yıldırım contributed equally to this work.

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Author: Atakan Aydın - Ahmet Biçer - Türker Özkan - Berkan Mersa - Safiye Özkan - Zeynep Hoşbay Yıldırım

Source: https://link.springer.com/







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