Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children with persistent obstetric brachial plexus palsy.

INTRODUCTION: Children with obstetric brachial plexus palsy (OBPP) frequently have problems related to their shoulder. The aim of the investigation was to determine our results in treating shoulder deformity with tendon transfers and soft tissue releases with and without internal rotational osteotomy. We also evaluated the relationships between neurological status, age and selected clinical parameters.

MATERIALS AND METHODS: We reviewed data of 25 patients (12 girls) after latissimus dorsi and teres major tendon transfers to the rotator cuff. Internal rotation osteotomy was performed in ten children. The mean age of patients at the time of operation was 3.2 years (range from 10 months to 7.7 years).

RESULT: Patients were followed up for a mean of 3.8 years (minimum 2 years). Mallet score improved 4.7 points at last follow-up (p = 0.00002). No patient had shoulder function deterioration. Active and passive external rotation increased significantly after operation: p < 0.00001, p < 0.00001, respectively. Statistically significant reduction in active internal rotation was noted (p = 0.04). The other movements have not statistically changed after operation. Active internal rotation difference after internal rotation osteotomy was significantly better than without osteotomy (p = 0.03). Neurological involvement and age had neither positive nor negative influence on final range of motion and outcome.

CONCLUSIONS: Soft tissue rebalancing procedures significantly improve shoulder function in children with persistent OBPP. Addition of internal rotational osteotomy to muscle transfers for severe cases allows maintaining of stabile joint, prevents loosening of internal rotation and does not influence other movements of the shoulder.