Surgical treatment of obstetrical palsy in sequela period

Obstetrical palsy caused by traction injury of brachial plexus during labour, either treated early or left untreated may lead to paralysis and contractures in the upper extremity. In such cases reconstructive surgery is required. 62 extremities of 61 patients in sequela period of obstetrical palsy operated in Çukurova Faculty of Medicine Orthopedics and Traumatology Department between January 1990-May 2001 were included in the study. In 42 (%67,7) of the extremities C5-6, in 15 (%24,2) C5-6-7 and in 5 (%8,1) C5-T1 involvement was present. In two cases bilateral severe whole arm type paralysis was present and one of them was operated bilaterally. 22 (%35,5) left and 40 (%64,5) right sided involvement was observed. Mean age of all patients at operation time was 10,29 (4-22) while in cases undergone soft tissue procedures about shoulder mean age was 8 and 13,3 for bony procedures. 2 trapezius transfers,one Harmon deltoid transfer, 2 Isp-TMn lengthenings, 2 SSc releases, 23 conbined anterior release and tendon transfers, one shoulder arthrodesis, 21 derotation osteotomies were the the operations performed in the shoulder region. Results of various procedures performed were analyzed after a mean follow up of 5 1,5 (6-138) months. Except one patient in which no improvement in range of motion was observed, all patients and parents were satisfied with the results. No statistically significant difference was detected between the cases of shoulder tendon transfer and derotation osteotomy. There is no standard treatment option for obstetrical palsy. Different surgical procedures should be performed taking care of patients age, type and severity of involvement, restriction in shoulder range of motion, muscle strength, glenohumeral joint deformity and experience of the surgeon. Key words: Brachial plexus, derotation osteotomy, obstetrical palsy, shoulder deformity, tendon transfer.