Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2015; 6(1): 156-160
Published online Jan 18, 2015. doi: 10.5312/wjo.v6.i1.156
Triangle tilt and humeral surgery: Meta-analysis of efficacy and functional outcome
Rahul K Nath, Chandra Somasundaram
Rahul K Nath, Chandra Somasundaram, Texas Nerve and Paralysis Institute, Houston, TX 77030, United States
Author contributions: Nath RK designed the study, performed the surgeries and revised the manuscript; Somasundaram C performed the literature search, statistical analysis and wrote the manuscript; both authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rahul K Nath, MD, Texas Nerve and Paralysis Institute, 6400 Fannin Street, Ste. 2420, Houston, TX 77030, United States. drnath@drnathmedical.com
Telephone: +1-713-5929900 Fax: +1-713-5929921
Received: December 25, 2013
Peer-review started: December 26, 2013
First decision: February 13, 2014
Revised: August 10, 2014
Accepted: September 4, 2014
Article in press: September 10, 2014
Published online: January 18, 2015
Processing time: 391 Days and 4.8 Hours
Abstract

AIM: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury (OBPI) patients.

METHODS: We conducted a literature search and identified original full research articles of OBPI patients treated with a secondary bony surgery, particularly addressing the limitation of shoulder abduction and functions. Further, we analyzed and compared the efficacy and the surgical outcomes of 9 humeral surgery papers with 179 patients, and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 patients.

RESULTS: Seven hundred and thirty-one articles were identified, using the search term “brachial plexus” and obstetric or pediatric (246 articles) or neonatal (219 articles) or congenital (188 articles) or “birth palsy” (121 articles). Further, only a few articles were identified using the bony surgery search, osteotomy “brachial plexus” obstetric (35), “humeral osteotomy” and “brachial plexus” (17), and triangle tilt “brachial plexus” (14). Of all, 12 studies reporting pre- and post- operative or improvement in total Mallet functional score were included in this study. Among these, 9 studies reported the humeral surgery and 4 were triangle tilt surgery. We used modified total Mallet functional score in this analysis. Various studies with humeral surgery showed improvement of 1.4, 2.3, 5.0 and 5.6 total Mallet score, whereas the triangle tilt surgery showed improvement of 5.0, 5.5, 6.0 and 6.2.

CONCLUSION: The triangle tilt surgery improves on what was achieved by humeral osteotomy in the management of shoulder function in OBPI patients.

Keywords: Meta-Analysis; Triangle tilt surgery; Humeral osteotomy; Obstetric brachial plexus injury; Birth palsy; SHEAR deformity; Shoulder function; Mallet score

Core tip: We systematically reviewed, analyzed and compared the surgical outcomes of 9 humeral surgery papers with 179 permanent obstetric brachial plexus injury patients (OBPI), and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 OBPI patients. We used modified total Mallet functional score in this analysis. Studies with humeral surgery showed improvement of 1.4, 2.3, 5.0 and 5.6 total Mallet score, whereas the triangle tilt surgery showed improvement of 5.0, 5.5, 6.0 and 6.2. The triangle tilt surgery improves on what was achieved by humeral osteotomy in the management of shoulder function in OBPI patients.