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Preventing Glenohumeral Dysplasia after Neonatal Brachial Plexus Injury: The Role of Early Tendon Transfers
Jeffrey N. Gross MD2, Neel D. Bhagat BS1, Chilando M. Mulenga BS1, Gregory H. Borschel MD2, Joshua M. Adkinson MD2
1 Indiana University School of Medicine
Indianapolis, IN
2 Division of Plastic Surgery, Department of Surgery
Indiana University School of Medicine
Indianapolis, IN
Indiana University
2023-01-31
Presenter: Jeffrey N Gross
Affidavit:
Jeffrey N Gross
Neel D. Bhagat
Chilando M. Mulenga
Gregory H. Borschel
Joshua M. Adkinson
Director Name: Dr. Bill Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction
Neonatal brachial plexus injury (BPI) is a rare but devastating complication of birth. An upper trunk BPI can result in the loss of shoulder external rotation and abduction and often leads to glenohumeral joint dysplasia (GJD). The latissimus dorsi/teres major tendon transfer (LTT) is a procedure used to restore external rotation and shoulder abduction and potentially reduce the incidence of GJD. Historically, this tendon transfer has been performed when the child is older and has demonstrated impaired shoulder function. In this study, we sought to review our experience with this procedure and to assess feasibility of LTT combined with BPI reconstruction.
Methods
A retrospective review of patients was performed. Inclusion criteria were patients under 18 years of age at Riley Children's Hospital with BPI who underwent LTT between 2021-2022.
Results
17 pediatric patients underwent LTT between 2021-2022. Patient age at time of surgery was 2.3 +/- 2.5 years. Four patients (23.5%) underwent the transfer concurrently with BPI reconstruction, 8 (47.1%) underwent the LTT in staged fashion, and 5 (29.4%) patients underwent the LTT with no previous or concurrent BPI reconstruction. Of the 8 patients that underwent a staged repaired 7/8 (88%) had MRI evidence of GHD prior to their tendon transfer.
Conclusions
In this study, we found that LTT can be safely and efficiently combined with BPI reconstruction. A simultaneous approach may provide the very young pediatric patient shoulder stability needed to prevent GHD. Future studies will focus on assessment of short-term and long-term shoulder-related outcomes.
