Primary and secondary shoulder reconstruction in obstetric brachial plexus palsy.

OBJECTIVES: In this retrospective review, the methods and outcomes in 96 children (98 extremities) with obstetric brachial plexus palsy who underwent primary reconstruction and/or palliative surgery for shoulder function were analysed.
METHODS: Thirty cases underwent primary reconstruction alone, 37 underwent both primary and secondary procedures, and 31 late cases underwent only palliative surgery. The mean follow-up period was 6.7 years.
RESULTS: The mean shoulder abduction increased from 48 degrees +/-32 degrees preoperatively to 123 degrees +/-35 degrees postoperatively (average gain 75 degrees ); the mean active external rotation with the arm at the side increased from -19 degrees +/-17 degrees to 62 degrees +/-21 degrees (mean gain 81 degrees ); and the mean aggregate Mallet score improved from 8.8 points to 20.9 points, respectively.
CONCLUSIONS: Reconstruction of both axillary and suprascapular nerves yielded improved outcomes of shoulder abduction and external rotation. Early plexus reconstruction (<or=3 months) offered the best functional results and reduced the need for secondary reconstructions. A marked improvement was observed after palliative surgery irrespective of prior nerve reconstruction. Rerouting of latissimus dorsi and/or teres major tendons, combined with extra-articular musculotendinous lengthening, significantly improved global shoulder function.