Article

Many children with permanent brachial plexus birth injury (BPBI)
develop shoulder problems, with subsequent joint deformity without treatment. We
assessed the indications and outcome of shoulder operations for BPBI. METHODS: 31 BPBI patients who had undergone a shoulder operation in our
hospital between March 2002 and December 2005 were included in the study.
Relocation of the humeral head had been performed in 13 patients, external
rotation osteotomy of the humerus in 5 patients, subscapular tendon lengthening
in 5 patients, and teres major transposition in 8 patients. Subjective results
were registered. Shoulder range of motion was measured, and function assessed
according to the Mallet scale. Magnetic resonance imaging (MRI) was performed
pre- and postoperatively. Glenoscapular angle (GSA) and percentage of humeral
head anterior to the middle of the glenoid fossa (PHHA) were measured. Congruency
of the glenohumeral joint (GHJ) was estimated. The mean follow-up time was 3.8
(1.7-6.8) years. RESULTS: At follow-up, the subjective result was satisfactory in
30 of the 31 patients. There were 4 failures, which in retrospect were due to
wrong choice of surgical method in 3 of these 4 patients. Mean increase in Mallet
score was 5.5 after successful relocation, 1.4 after rotation osteotomy, 2.2
after subscapular tendon lengthening, and 3.1 after teres major transposition.
Congruency of the shoulder joint improved in 10 of 13 patients who had undergone
a relocation operation, with mean improvement in GSA of 33 masculine and mean
increase in PHHA of 25%. There were no substantial changes in congruency of the
glenohumeral joint in patients treated with other operation types.
INTERPRETATION: Restriction of the range of motion and malposition of the
glenohumeral joint can be improved surgically in brachial plexus birth injury.
Remodeling of the joint takes place after successful relocation of the humeral
head in young patients.

Langue : ANGLAIS