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• W2887098167 abstract "INTRODUCTION: For centuries obstetric brachial plexus palsy was confused withother congenital conditions.Smellie in 1795 is credited with the first description of a child withbilateral weakness of both upperlimbs who rapidly recovered.Danyou in 1851 described autopsy findings in a 8 day old baby inwhom the upper trunk was infiltrated with blood but not ruptured . Duchenne described patients who presented with an unusual injury, of avulsion of C5 and C6.Klumpke described lesions of lower nerves of the brachial plexus.Trombetta in 1880 identified two groups of babies particularly at risk - the heavy baby and baby born by breech.Duval and Guillian in 1898, showed that the brachial plexus was stretched and C5 and C6 were prone to rupture when shoulder was forcibly depressed.Boyer found a lesion in the spinal cord at autopsy in a 41 year old woman.In the beginning of the century there was much interest in operativerepair. Kennedy in 1903 described three early repairs of upper trunk inobstetric palsy. Clark in 1905 described seven early nerve repair and in1920 taylor operated on 80 cases of obstetric palsy out of 200 cases.Wyeth and Sharpe after reviewing 81 cases, recommendedoperation at the age of 1 month in complete lesions and at 3 months forincomplete lesions with no spontaneous improvement.AIM: To analyse the functional results of muscle transfer for restoringabduction and external rotation in old obstetric brachial plexus palsy.MATERIALS AND METHODS: This is a prospective study of 15 cases of old obstetric brachial plexus palsy with shoulder sequelae for whom latissimus dorsi and teresmajor muscle transfer was done for restoring abduction and external rotation.The period of surgery and followup extends from November 2007 to November 2009. In our series, nine were boys and six were girls. The age ranged from 3 to 14 years at time of surgery with an average of 6 years and 3 months. Ten children were affected on the right side and five on the left side. Thirteen cases were of the classical upper arm type and two cases were of whole arm type of brachial plexus palsy. Of the fifteen cases seven cases gave history of difficult labour which varied from breech, instrumental delivery to vaccum extraction. All the fifteen patients were followed up with a minimum followup period of 6 months to a maximum followup period of two and half years. The average followup period being two years.RESULTS: In our series of cases the average post operative abduction was114.75 degrees, as against pre-operative value of 65.25 degrees for theupper arm type of palsy. We compared the results of upper and the wholearm types separately as the overall functional outcome varied widelybecause of the wrist and hand involvement in the whole arm types. Theaverage abduction was improved from 15 degrees to 65 degrees inchildren with the whole arm type of palsy.All cases of upper arm type of obstetric brachial plexus palsyshowed significant improvement in abduction and external rotationcharacterized by higher mallet scores (class IV and class V) in all the cases.It was also observed that there was no difference in age at the timeof surgery to the ultimate functional results.Also it was noted that patients with moderate range of abductionand external rotation preoperatively had significant improvement inabduction and external rotation post operatively. There was nodeterioration in range of motion in any of our patients.CONCLUSION: The surgeon has to be aware of muscle imbalance and internalrotation contracture in all cases of old obstetric brachial plexuses palsy.Early and timely surgical release and muscle transfer even as earlyas 2 years prevents glenohumeral deformities and improves the functionof shoulder joint.Correct choice of surgical procedure will improve the function andoutlook in these patients.Latissimus dorsi and teres major muscle transfer restores abductionand external rotation in most of the patients with late obstetric brachialplexus palsy. Apart from functional improvement this procedure correctsa deformity thereby easing the psycho-social stigma associated with it,especially in our part of the country.Muscle transfer definitely deserves role in the armamentarium ofthe reconstructive surgeon treating patients with shoulder deformity andweakness after obstetric brachial plexus palsy." @default.
• W2887098167 created "2018-08-22" @default.
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• W2887098167 date "2010-03-01" @default.
• W2887098167 modified "2023-09-24" @default.
• W2887098167 title "A study of functional results of muscle transfer for restoring abduction and external rotation in old obstetric brachial plexus palsy" @default.
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