Surgical correction of the medial rotation contracture in obstetric brachial plexus palsy

• Published in: Journal of bone and joint surgery. British volume Vol. 89; no. 12; pp. 1638 - 1644
• Main Authors: Nath, R K, Lyons, A B, Melcher, S E, Paizi, M
• Format: Journal Article
• Language: English
• Published: England British Editorial Society of Bone & Joint Surgery 01-12-2007
• Edition: British volume
• Subjects: Birth Injuries - complications; Brachial Plexus Neuropathies - complications; Child; Child, Preschool; Contracture - surgery; Female; Follow-Up Studies; Humans; Joint Deformities, Acquired - diagnostic imaging; Joint Deformities, Acquired - etiology; Joint Deformities, Acquired - surgery; Male; Range of Motion, Articular; Shoulder Dislocation - diagnostic imaging; Shoulder Dislocation - etiology; Shoulder Dislocation - surgery; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.89B12.18757

The medial rotation contracture caused by weak external rotation secondary to obstetric brachial plexus injury leads to deformation of the bones of the shoulder. Scapular hypoplasia, elevation and rotation deformity are accompanied by progressive dislocation of the humeral head. Between February and August 2005, 44 children underwent a new surgical procedure called the 'triangle tilt' operation to correct this bony shoulder deformity. Surgical levelling of the distal acromioclavicular triangle combined with tightening of the posterior glenohumeral capsule (capsulorrhaphy) improved shoulder function and corrected the glenohumeral axis in these patients. The posture of the arm at rest was improved and active external rotation increased by a mean of 53 degrees (0 degrees to 115 degrees ) in the 40 children who were followed up for more than one year. There was a mean improvement of 4.9 points (1.7 to 8.3) of the Mallet shoulder function score after surgical correction of the bony deformity.