TITLE:
Comparing the Surgical Outcomes of Modified Quad and Triangle Tilt Surgeries to other Procedures Performed in Obstetric Brachial Plexus Injury
AUTHORS:
Rahul K. Nath, Juan-Carlos Pretto, Chandra Somasundaram
KEYWORDS:
Obstetric Brachial Plexus Injury; Triangle Tilt Surgery; Modified Quad Surgery; Modified Mallet; Radiological Score
JOURNAL NAME:
Surgical Science,
Vol.4 No.9A,
August
5,
2013
ABSTRACT: Purpose: To compare results from our surgical
treatment experiences in children with obstetric brachial plexus injuries
(OBPI), to those who have had other surgical treatments. Methods: We conducted a retrospective study in our medical records
consisting of two groups of OBPI patients. Group
1: 26 OBPI children (16 girls and 10 boys), age range between
2.0 and 12.0 (mean age 6.9), who have undergone surgical treatments at other
institutions between 2005 and 2010. Group
2: 45 OBPI children (20 boys and 25 girls), age between 0.7 and 12.9 (mean
age 3.7), who have had modified Quad and triangle tilt surgical treatment between
2005 and 2010 at our institution. In both groups Mean modified
Mallet scores and radiological scores were measured and compared. All
measurements were made at least one year post surgery in both groups. Results: Post-operative mean modified
Mallet score was 11.8 ± 2.4 in
group 1 patients, whereas post-mean modified Mallet score was 20 ± 2.7 (P 0.0001) following modified Quad and triangle tilt surgeries in group
2 patients. Further, their radiological scores such as posterior subluxation,
and glenoid version were 13.4 ± 21.3 and ﹣30.2 ± 19.1 in group 1, whereas 32.1 ±13.5 (P 0.0004), and ﹣16.3 ± 11.5 (P 0.008)
in group 2 patients, when compared to normal values of 50, and 0 respectively. Conclusion: Patients who have had mod
Quad and triangle tilt for OBPI obtained significantly better functional
outcomes in modified total Mallet score as well as in radiological scores, when
compared to those OBPI children, who underwent other procedures such as
posterior glenohumeral capsulorrhaphy, biceps tendon lengthening,
humeral osteotomy, anterior capsule release, nerve transfer/graft, botox and muscle/tendon
transfer and release.