Evaluating the outcome of different reconstructive surgical options for the management of shoulder deformity following obstetrical brachial plexus injury due to Erb’s palsy
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Keywords
Obstetrical brachial plexus paralysis, derotation osteotomy, trapezius tendon transfer
Abstract
Background: Obstetrical brachial plexus paralysis (OBPP) refers to an injury to all or part of the brachial plexus occurring at the time of delivery. Injuries associated with the upper brachial plexus are termed Erb’s palsy, while those associated with the lower brachial plexus are referred to as Klumpke palsy. Obstetrical brachial plexus injuries are often associated with large birth weight and shoulder dystocia. Aim: This study aims to evaluate the outcomes of different secondary reconstructive surgical options for the treatment of OBPP Methods: This prospective study was conducted at Basra General Hospital from October 2022 to November 2023. Sixty-eight patients (43 males and 25 females) were included, with 49 patients experiencing right-side involvement and 19 with left-side involvement. All patients had Grade 2 OBPP according to the modified Mallet score. Secondary reconstruction involved subscapularis release for 48 patients, derotation osteotomy for 12 patients with fixation using plates and screws, and tendon transfer for eight patients in the form of trapezius transfer to the upper humerus. Results: In the subscapularis release group, 42 out of 48 patients (87.5%) reported satisfaction with the surgical outcome, noting improvements in their ability to eat and drink. In the derotation osteotomy group, 11 out of 12 patients (81.7%) were satisfied with the result of surgery, while the trapezius transfer group expressed dissatisfaction with the surgical outcome. Conclusion: Subscapularis release surgery is suitable for early and flexible OBPP, yielding satisfactory results, while derotation osteotomy is appropriate for fixed OBPP in toddlers and older children, also demonstrating good results. Trapezius tendon transfer showed unsatisfactory outcomes.
References
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Thamer A. Hamdan , Professor of Orthopedic Surgery, University of Basra/College of Medicine, FRCS, FRCP, FICS, FACS
Professor of Orthopedic Surgery, University of Basra/College of Medicine, FRCS, FRCP, FICS, FACS