Triangle tilt and humeral surgery: Meta-analysis of efficacy and functional outcome

Table 1 Bony surgical procedures and outcomes in obstetric brachial plexus injury patients

Name of thesurgery	Ref.	No. of patients (age at surgery)	Follow-up (yr)	Surgical outcomes
Internal/external rotational/derotational osteotomy of the humerus	Abzug et al[13]	23 patients Mean age 10.1	2.2	13.8 ± 2.8, 16.1 ± 2.5 (P = 0.002), Mallet increased about 2.3
	Al-Qattan[7]	15 patients mean age 6.5	3	Mallet increased about 4.0
	Al-Qattan et al[9]	13 patients mean age 6 (4.5-9)	2	Improved the cosmetic appearance
	Al-Qattan[8]	17 patients mean age 6 (range 8-14) Recalled back to the clinic at a mean of 10 yr (range 8-14) after surgery. Mean age of 16, (range 13-20)	10	Found surprisingly, a significant (P = 0.003) decrease in shoulder abduction on long-term follow-up (the mean shoulder abduction was 135º, 146º and 109º measured pre-, early post- and late postoperatively, respectively)
	Waters et al[1]	16 patients mean age 8.4	3	Mallet improved 9.5 to 15.1 (P < 0.001)
	Waters et al[12]	27 patients mean age 7.6 range 2. 3-17	3.7	Mallet improved13 to 18 (P = 0.01). External rotation achieved with osteotomy was 64° (range, 35° to 90°)
	Pöyhiä et al[15]	5 patients	3.8	Mallet increased about 1.4 (P = 0.1)
	Kirkoset al[14]	22 patients mean age 10.0 age range 5-12	Vary, no mean	Increase in active abduction of the arm was 27 º (range, 0 to 60), and the average increase in the arc of rotation was 25 º (range, 5 to 85)
	Al-Zahrani[6]	12 patients age range 0.5 to 6	3.5 (1-5)	Cosmetic and functional improvement. ER improved 32º (20-40), abduction improved about 61º (60-70).
Relocation of the humerus	Pöyhiä et al[15]	13 patients	3.8	Mallet increased about 5.5 (P = 0.003)
Triangle Tilt surgery	Nath et al[16]	4 patients, mean age 10.2 (range 7.9-11.9)	< 1.0	Mallet improved 12.8 to 18.3 (P < 0.05)
	Nath et al[17]	40 patients, mean age 6.5 (range 2.2-10.3)	1.3	Mallet improved 13.6 to 18.6 (P < 0.000)
	Nath et al[20]	20 patients, mean age 5.0 (range 1.3-13)	1.5	Mallet improved about 6.0 (P < 0.001)
	Nath et al[18]	22 patients, mean age 5.8 (range 2.1-11.8)	5	Mallet improved 14.1 to 20.3 extended long term follow-up (5 yr, P < 0.0001)