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Surgical reduction of brachial plexus injuries in children may yield greater abduction contracture
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BOSTON — Compared with patients who had no reduction, pediatric patients with brachial plexus injuries who required surgical reduction experienced greater abduction contracture, which may lead to greater overhead motion but showed high risk for loss of midline function and lower perceived outcomes, according to results presented at the American Society for Surgery of the Hand Annual Meeting.
Stephanie A. Russo, MD, PhD, and colleagues measured static glenohumeral joint angles with the arm resting by the side in abduction, external rotation and the hand-to-neck position among 54 children with brachial plexus injuries who either had a tendon transfer or no other secondary surgery for the shoulder. Researchers calculated the difference in average preoperative and postoperative modified Mallet scores and assessed patients’ difficulty in performing activities using the brachial plexus computer adaptive test short form. Researchers classified the glenohumeral joint reduction method as none when the glenohumeral joint was concentric preoperatively, closed or surgical when the capsule was incised.
Russo noted significantly greater glenohumeral elevation in the neutral and external rotation positions among patients in the closed reduction group, while patients in the surgical group had significantly greater glenohumeral elevation in all tested positions. The surgical group had an increased angle about 20° larger when compared with the no reduction group, which was maintained throughout all tested positions, she said.
“The only difference in glenohumeral displacement was external rotation for the hand-to-neck position in the closed reduction group,” Russo said.
The groups showed no differences in modified Mallet scores, according to Russo. She added that the no reduction group had significantly better brachial plexus computer adaptive test short form scores.
“The surgical reduction group had the largest loss of midline function at 20%, but overall for the all the groups, there was worse midline function in the majority of patients postoperatively,” Russo said. – by Casey Tingle
Reference:
Russo SA, et al. Paper 26. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 13-15, 2018; Boston.
Disclosure: This paper received grant support from Shriners Hospitals for Children Clinical Research Grant.