Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2016; 7(11): 752-757
Published online Nov 18, 2016. doi: 10.5312/wjo.v7.i11.752
Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy
Rahul K Nath, Chandra Somasundaram
Rahul K Nath, Chandra Somasundaram, Texas Nerve and Paralysis Institute, Houston, TX 77030, United States
Author contributions: Nath RK conceived of the study, performed all the surgeries and revised the manuscript; Somasundaram C participated in the design of the study, performed the statistical analysis and drafted the manuscript; both authors read and approved the final manuscript.
Institutional review board statement: This was a retrospective study of patient charts, which exempted it from the need for IRB approval in the United States. Patients were treated ethically in compliance with the Helsinki declaration. Documented informed consent was obtained for all patients.
Informed consent statement: Written informed consent was obtained from all patients for publication and accompanying images. A copy of the written consent is available for review on request.
Conflict-of-interest statement: The authors report that there are no conflicts of interest.
Data sharing statement: No.
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: Dr. Rahul K Nath, Texas Nerve and Paralysis Institute, 6400. Fannin St., Houston, TX 77030, United States. drnath@drnathmedical.com
Telephone: +1-713-5909900 Fax: +1-713-5909921
Received: March 23, 2016
Peer-review started: March 24, 2016
First decision: July 5, 2016
Revised: August 6, 2016
Accepted: September 7, 2016
Article in press: September 8, 2016
Published online: November 18, 2016
Processing time: 235 Days and 19.9 Hours
Abstract
AIM

To compare outcomes of our revision surgical operations in obstetric brachial plexus palsy (OBPP) patients to results of conventional operative procedures at other institutions.

METHODS

We analyzed our OBPP data and identified 10 female and 10 male children aged 2.0 to 11.8 years (average age 6.5 years), who had prior conventional surgical therapies at other clinics. Of the 20 patients, 18 undergone triangle tilt, 2 had only mod Quad. Among 18 patients, 8 had only triangle tilt and 10 had also mod Quad as revision surgeries with us. We analyzed the anatomical improvements and functional modified Mallet statistically before and after a year post-revision operations.

RESULTS

Pre-revision surgery average modified Mallet score was 12.0 ± 1.5. This functional score was greatly improved to 18 ± 2.3 (P < 0.0001) at least one-year after revision surgical procedures. Radiological scores (PHHA and glenoid version) were also improved significantly to 31.9 ± 13.6 (P < 0.001), -16.3 ± 11 (P < 0.0002), at least one-year after triangle tilt procedure. Their mean pre-triangle tilt (yet after other surgeon’s surgeries) PHHA, glenoid version and SHEAR were 14.6 ± 21.7, -31.6 ± 19.3 and 16.1 ± 14.7 respectively.

CONCLUSION

We demonstrate here, mod Quad and triangle tilt as successful revision surgical procedures in 20 OBPP patients, who had other surgical treatments at other clinics before presenting to us for further treatment.

Keywords: Revision surgery; Obstetric brachial plexus palsy; Shoulder movements; Joint incongruity; Upper limb

Core tip: We compared functional and anatomical improvements from our revision surgical treatment experiences to outcomes of other surgical treatments at other institutions in 20 obstetric brachial plexus palsy (OBPP) children. Pre-revision surgery mean modified Mallet scores and shoulder anatomical measurements were improved statistically highly significantly at least one-year after revision surgeries. We demonstrate here, mod Quad and triangle tilt as successful revision surgical procedures in 20 OBPP patients, who had other surgical treatments at other clinics before presenting to us for further treatment.