Functional evaluation of soft tissue procedures in birch type 1 cases

Shoulder internal rotation and adduction contractures, and permanent abduction and weakness of external rotation are very common in residual brachial plexus birth palsy (BPBP). If neural surgery (nerve graft, nerve transfers) has not been performed or if adequate improvement in C5 functions has not been achieved, abduction and external rotation functions can be significantly increased with the help of muscle transfers and soft tissue releases. In this study, 148 patients who underwent tendon transfer for shoulder internal rotation contracture and abduction / external rotation loss due to brachial plexus birth palsy in the Department of Orthopedics and Traumatology of Hacettepe University Faculty of Medicine between 2008 and 2019 were examined. Functional measurements (Modified Mallet Scale) recorded before and after the tendon transfer procedure were retrospectively scanned from archive records. In the sample group of 148 patients, not only a single surgical procedure, but different combinations of tendon transfer and release were performed. For all patients, the global abduction score increased from an average of 2.7 to 3.9 postoperatively, resulting in an increase of 1.2 points in abduction. Global external rotation mean Mallet Score was 2.6 preoperatively, but postoperatively 3.6, 1 point increase. Similarly, postoperative functional progress was achieved in the movements of carrying the hand to the neck and moving the hand to the mouth. However, there was a decrease in the postoperative mean score in the movements of bringing the hand to the waist and internal rotation, which are indicators of internal rotation and midline functions. Considering the change in Modified Mallet Scores, there are some significant differences between the groups, although there are similar functional changes in the patients who underwent isolated latissimus dorsi, isolated teres major or combined latissimus dorsi and teres major tendon transfers. The results of patients who underwent isolated teres major transfer stand out, especially because of the significantly less impairment in midline and internal rotation functions.