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Reoperation for failed shoulder reconstruction following brachial plexus birth injury.

Price AE, Fajardo M, Grossman JA - J Brachial Plex Peripher Nerve Inj (2013)

Bottom Line: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy.In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem.This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA. aprice@pedsorthoservices.com.

ABSTRACT

Background: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure.

Case presentations: This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation.

Conclusions: This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

No MeSH data available.


Related in: MedlinePlus

Neurovascular pedicle to teres major must be identified and protected during transfer. It is shorter and less mobile than the pedicle to latisimus dorsi.
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Figure 3: Neurovascular pedicle to teres major must be identified and protected during transfer. It is shorter and less mobile than the pedicle to latisimus dorsi.

Mentions: A major soft tissue problem to be avoided is injury to the teres major neurovascular pedicle (Cases 1, 2, 5, and 7). When transferring the teres major (and/or the latissimus dorsi), it is important to identify and protect the neurovascular pedicles (FigureĀ 3). Fortunately in these cases, the latissimus dorsi was still available for transfer. The transferred tendon should be brought over the long head of the triceps and sewn into the infraspinatus tendon to supplement external rotation and shoulder elevation[18]. We use at least 3 non-absorbable sutures to secure the transferred tendon. Immobilization in 60 degrees of external rotation and 30 degrees abduction is maintained for a period of 6 weeks, and the postoperative therapy program includes restoration of internal and external rotation, strengthening, and constraint-induced therapy.


Reoperation for failed shoulder reconstruction following brachial plexus birth injury.

Price AE, Fajardo M, Grossman JA - J Brachial Plex Peripher Nerve Inj (2013)

Neurovascular pedicle to teres major must be identified and protected during transfer. It is shorter and less mobile than the pedicle to latisimus dorsi.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750868&req=5

Figure 3: Neurovascular pedicle to teres major must be identified and protected during transfer. It is shorter and less mobile than the pedicle to latisimus dorsi.
Mentions: A major soft tissue problem to be avoided is injury to the teres major neurovascular pedicle (Cases 1, 2, 5, and 7). When transferring the teres major (and/or the latissimus dorsi), it is important to identify and protect the neurovascular pedicles (FigureĀ 3). Fortunately in these cases, the latissimus dorsi was still available for transfer. The transferred tendon should be brought over the long head of the triceps and sewn into the infraspinatus tendon to supplement external rotation and shoulder elevation[18]. We use at least 3 non-absorbable sutures to secure the transferred tendon. Immobilization in 60 degrees of external rotation and 30 degrees abduction is maintained for a period of 6 weeks, and the postoperative therapy program includes restoration of internal and external rotation, strengthening, and constraint-induced therapy.

Bottom Line: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy.In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem.This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA. aprice@pedsorthoservices.com.

ABSTRACT

Background: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure.

Case presentations: This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation.

Conclusions: This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

No MeSH data available.


Related in: MedlinePlus