Primary and secondary shoulder reconstruction in obstetric brachial plexus palsy

Objectives: In this retrospective review, the methods and outcomes in 96 children (98 extremities) with obstetric brachial plexus palsy who underwent primary reconstruction and/or palliative surgery for shoulder function were analysed. Methods: Thirty cases underwent primary reconstruction alone, 37 underwent both primary and secondary procedures, and 31 late cases underwent only palliative surgery. The mean follow-up period was 6.7 years. Results: The mean shoulder abduction increased from 48 +/- 32 preoperatively to 123 +/- 35 postoperatively (average gain 75 degrees); the mean active external rotation with the arm at the side increased from -19 degrees +/- 17 degrees to 62 degrees +/- 21 degrees (mean gain 81 degrees); and the mean aggregate Mallet score improved from 8.8 points to 20.9 points, respectively. Conclusions: Reconstruction of both axillary and suprascapular nerves yielded improved outcomes of shoulder abduction and external rotation. Early plexus reconstruction (<= 3 months) offered the best functional results and reduced the need for secondary reconstructions. A marked improvement was observed after palliative surgery irrespective of prior nerve reconstruction. Rerouting of latissimus dorsi and/or teres major tendons, combined with extra-articular musculotendinous lengthening, significantly improved global shoulder function. (C) 2008 Elsevier Ltd. All. rights reserved.