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Treatment of residual obstetrical brachial plexus palsy with tendon transfer

Year 2002, Volume: 36 Issue: 4, 295 - 302, 11.09.2006

Abstract

Objectives: We evaluated the results of the correction of adduction and internal rotation deformities of the shoulder associated with residual obstetrical brachial plexus palsy (OBPP) by the transfer of latissimus dorsi and teres major muscles to the rotator cuff.
Methods: In order to correct adduction and internal rotation deformities associated with residual OBPP, 10 patients (7 males, 3 females; mean age 8.1 years; range 4 to 19 years) underwent transfer of the latissimus dorsi and teres major muscles to the rotator cuff and lengthening of the pectoralis major tendon with Z-plasty. The right and left extremities were affected in seven and three patients, respectively. Involvement of the C5-C6 nerve roots was detected in four, and C5-C6-C7 nerve roots in six patients. In two patients with a positive Putti sign, axillary roentgenograms showed posterior subluxation of the humeral head, and magnetic resonance and computed tomography scans revealed type III glenohumeral deformity. Functional evaluations were made using a 5-point scoring system proposed by Mallet. The mean follow-up was 23.6 months (5 to 42 months).
Results: Postoperatively, the mean abduction and external rotation were 134.5° (range 95° to 170°) and 70° (range 45° to 90°), respectively. The mean global abduction score was 4, external rotation score was 4.2, and the scores assigned to the ability to move hand to the neck and mouth were 3.5. Of two patients with type III glenohumeral deformity, whose ages were four and 19 years, abduction and external rotation were 150° and 45° in the former, 135° and 70° in the latter, respectively.
Conclusion: The transfer of the latissimus dorsi and teres major tendons is a necessary procedure to restore external rotation and abduction functions of paralysed shoulders. Compared to other techniques employed, it offers obvious advantages in terms of ease and cost, as well.

Rezidüel obstetrikal brakial pleksus paralizisi tedavisinde tendon transferi

Year 2002, Volume: 36 Issue: 4, 295 - 302, 11.09.2006

Abstract

Amaç: Rezidüel obstetrikal brakial pleksus paralizisine (OBPP) bağlı omuz adduksiyon-iç rotasyon deformitesinin, latissimus dorsi ve teres majör tendonlarının rotator manşete transferi ile düzeltildiği olgularda sonuçlar değerlendirildi.
Çalışma planı: Rezidüel OBPP’ye bağlı omuz addüksiyon-iç rotasyon deformitesi saptanan 10 hastada (7 erkek, 3 kız; ort. yaş 8.1; dağılım 4-19) latissimus dorsi ve teres majör tendonlarının rotator manşete transferi yapıldı ve pektoralis majör tendonu Z-plasti ile uzatıldı. Yedi olguda sağ, üç olguda sol üst ekstremite etkilenmişti. Dört olguda C5-C6, altı olguda C5-C6-C7 sinir kökleri tutulumu vardı. İki hastanın muayenesinde “Putti sign” pozitif bulundu ve aksiller grafilerinde humerus başı posterior subluksasyonu; manyetik rezonans görüntüleme ve bilgisayarlı tomografi incelemelerinde tip III glenohumeral deformite gözlendi. Ameliyat sonrası fonksiyonel değerlendirme Mallet’in 5 puanlık omuz fonksiyonel skorlama sistemine göre yapıldı. Ortalama takip süresi 23.6 ay (dağılım 5-42 ay) idi.
Sonuçlar: Ameliyat sonrası abdüksiyon ve dış rotasyon ortalamaları sırasıyla 134.5° (dağılım 95-170°) ve 70° (dağılım 45-90°) bulundu. Ortalama global abdüksiyon skoru 4; dış rotasyon skoru 4.2; eli ağza ve boyna götürebilme skorları 3.5 bulundu. Tip III glenohumeral deformiteli iki olgudan birinde (4 yaş) ameliyat sonrası abdüksiyon 150°, dış rotasyon 45°; diğerinde (19 yaş) abdüksiyon 135°, dış rotasyon 70° ölçüldü.
Çıkarımlar: Rezidüel obstetrikal brakial pleksus paralizili hastalarda omzun dış rotasyon ve abdüksiyonunun kazanılması için latissimus dorsi ve teres majör tendon transferi, hem gerekli hem de diğer yöntemlere göre ucuz ve uygulanması daha kolay bir tekniktir.

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Details

Primary Language English
Journal Section Original Article
Authors

Mehmet Demirhan This is me

Mehmet Erdem This is me

Mustafa Uysal This is me

Publication Date September 11, 2006
Published in Issue Year 2002 Volume: 36 Issue: 4

Cite

APA Demirhan, M., Erdem, M., & Uysal, M. (2006). Treatment of residual obstetrical brachial plexus palsy with tendon transfer. Acta Orthopaedica Et Traumatologica Turcica, 36(4), 295-302. https://doi.org/10.3944/aott.v36i4.876
AMA Demirhan M, Erdem M, Uysal M. Treatment of residual obstetrical brachial plexus palsy with tendon transfer. Acta Orthopaedica et Traumatologica Turcica. September 2006;36(4):295-302. doi:10.3944/aott.v36i4.876
Chicago Demirhan, Mehmet, Mehmet Erdem, and Mustafa Uysal. “Treatment of Residual Obstetrical Brachial Plexus Palsy With Tendon Transfer”. Acta Orthopaedica Et Traumatologica Turcica 36, no. 4 (September 2006): 295-302. https://doi.org/10.3944/aott.v36i4.876.
EndNote Demirhan M, Erdem M, Uysal M (September 1, 2006) Treatment of residual obstetrical brachial plexus palsy with tendon transfer. Acta Orthopaedica et Traumatologica Turcica 36 4 295–302.
IEEE M. Demirhan, M. Erdem, and M. Uysal, “Treatment of residual obstetrical brachial plexus palsy with tendon transfer”, Acta Orthopaedica et Traumatologica Turcica, vol. 36, no. 4, pp. 295–302, 2006, doi: 10.3944/aott.v36i4.876.
ISNAD Demirhan, Mehmet et al. “Treatment of Residual Obstetrical Brachial Plexus Palsy With Tendon Transfer”. Acta Orthopaedica et Traumatologica Turcica 36/4 (September 2006), 295-302. https://doi.org/10.3944/aott.v36i4.876.
JAMA Demirhan M, Erdem M, Uysal M. Treatment of residual obstetrical brachial plexus palsy with tendon transfer. Acta Orthopaedica et Traumatologica Turcica. 2006;36:295–302.
MLA Demirhan, Mehmet et al. “Treatment of Residual Obstetrical Brachial Plexus Palsy With Tendon Transfer”. Acta Orthopaedica Et Traumatologica Turcica, vol. 36, no. 4, 2006, pp. 295-02, doi:10.3944/aott.v36i4.876.
Vancouver Demirhan M, Erdem M, Uysal M. Treatment of residual obstetrical brachial plexus palsy with tendon transfer. Acta Orthopaedica et Traumatologica Turcica. 2006;36(4):295-302.