CONSIDERATIONS FOR SURGICAL PLANNING OF HUMERAL OSTEOTOMY IN BRACHIAL PLEXUS BIRTH PALSY BASED ON THE ELBOW CREASE AND HUMERAL RETROVERSION MEASUREMENT

Authors

  • Flavio Cesar Ivalde Peripheral Nerve & Brachial Plexus Surgery Program, Department of Orthopedics, University of Buenos Aires School of Medicine, Buenos Aires, Argentina. http://orcid.org/0000-0003-1232-8065
  • Jose Marazita-Valverde Peripheral Nerve & Brachial Plexus Surgery Program, Department of Orthopedics, University of Buenos Aires School of Medicine, Buenos Aires, Argentina. http://orcid.org/0000-0003-2419-0761
  • Danilo Bataglia Peripheral Nerve & Brachial Plexus Surgery Program, Department of Physiotherapy, University of Buenos Aires School of Medicine, Buenos Aires, Argentina. http://orcid.org/0000-0001-8105-9634

Abstract

In obstetric brachial plexus, injuries are characterized by contractures, weakness and an association with different bone deformities, such as elongation of the coracoid process and/or acromion, retroversion of the glenoid cavity, flattening of the humeral head and Scapular Hypoplasia with Elevation and Rotation (SHEAR). Another humeral deformity is the retroversion of the humeral head, cases of which are increased in the presence of plexus lesions.  The purpose of the current manuscript is to highlight two aspects of this latter deformity. First, the importance of taking into consideration the reduction of a humeral retroversion as a quantifiable bone deformity (by medical imaging technique) along with the other bone deformities previously mentioned. Finally, the complementation of these measurements by the clinical measures of the anterior crease of the elbow to rebuild the plane of motion to a level comparable to that of the healthy side, thereby avoiding excessive exorotation, would facilitate and improve the planning of surgical strategies for each patient.

References

Yarfi C, Elekusi C, Banson AN, Angmorterh SK, Kortei NK, Ofori EK. Prevalence and predisposing factors of brachial plexus birth palsy (BPBP) in a regional hospital in Ghana: a five year retrospective study. Pan Afr Med J 2019;32:211.

O’Berry P, Brown M, Phillips L, Helen Evans S. Obstetrical Brachial Plexus Palsy. Curr Probl Pediatr Adolesc Health Care 2017;47(7):151–5.

Pearl ML, Edgerton BW. Glenoid deformityretrieves secondary to brachial plexus birth palsy. J Bone Joint Surg Am 1998;80(5):659–67.

Öztuna V, Öztürk H, Eskandari MM, Kuyurtar F. Measurement of the humeral head retroversion angle. A new radiographic method. Arch Orthop Trauma Surg 2002;122(7):406–9.

van de Bunt F, Pearl ML, van Essen T, van der Sluijs JA. Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy. World J Orthop 2018;9(12)292–9.

Greenhill DA, Trionfo A, Ramsey F V, Kozin SH, Zlotolow DA. Postoperative Loss of Midline Function in Brachial Plexus Birth Palsy. J Hand Surg Am 2018;43(6):565.e1–565.e10.

Abzug JM, Wyrick-Glover TO, Case AL, Zlotolow DA, Kozin SH. Loss of Midline Function in Brachial Plexus Birth Palsy Patients. J Pediatr Orthop 2019;39(3):232–5.

Ivalde FC, Miguens GN, Socolovsky M. Using the main elbow flexion skin crease as an intraoperative parameter to determine the degree of exorotation needed for humeral derotational osteotomies in upper-type brachial plexus patients. J Orthop Surg (Hong Kong) 2018;26(3):230949901879271.

Mattar Júnior R, Kimura LK, Oviedo RM, Silva BL de S, Cho ÁB, Crepaldi BE. Role of early shoulder tomography on the obstetric brachial plexus palsy. Acta Ortop Bras 2015;23(1):22–5.

Pearl ML, Batech M, Van De Bunt F. Humeral retroversion in children with shoulder internal rotation contractures secondary to upper-trunk neonatal brachial plexus palsy. J Bone Joint Surg Am 2016;98(23):1988–95.

Itamura JM, Papadakis SA, Vaishnav S, Gurmet R. The relationship between main elbow flexion skin crease and osseous anatomy of the elbow joint. Surg Radiol Anat 2009;31(1):55–8.

Published

2019-12-31

Issue

Vol. 31 No. 4 (2019): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

EDITORIAL

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.