Treatment of posterior dislocation of the shoulder secondary to brachial plexus birth palsy

Twenty patients [12 males and 8 females] with posterior dislocation of the shoulder secondary to brachial plexus birth palsy were treated with open reduction of the shoulder joint via an anterior approach. Age range at the time of surgery was from one to 11 years [average of six years]. Ten of the palsies involved the fifth and sixth cervical nerve roots, five involved the fifth, sixth and seventh cervical nerve roots and five involved the whole plexus. The diagnosis was suspected on clinical grounds and confirmed by CT or MRI. The mean duration of follow-up was three years [range 1.5 to 4 years]. There was no redislocation in this period and all the children are free of any shoulder orthosis. With Mallet scoring, all patients had an average improvement of 1.2 grades for abduction, 1.7 grades for external rotation, 1.8 grades for hand to mouth ability and 1.4 grades for hand to neck ability and internal rotation contracture was improved in all patients. Patients with C5, C6 level involvement tended to experience greater abduction postoperatively. In addition, patients with diffuse plexopathy tended to have lower postoperative global Mallet scores. Open reduction of the shoulder joint via an anterior approach in children who have paralytic dislocation of the shoulder due to muscle imbalance secondary to brachial plexus birth palsy is effective and improved the function of the shoulder even in very late cases and release of the contracted muscles enabled to perform the reduction easily

Treatment of congential pseudoarthrosis of the tibia using the Ilizarov technique

Twelve patients suffering from congenital pseudoarthrosis of the tibia were treated using the Ilizarov technique. Seven patients were males and five were females with an average age 7 years 7 months [range 3 years 2 months to 16 years 3 months]. Various methods were used to treat the pseudoarthrosis site including compression in five cases, distraction in three cases, resection and bone transport in one case and resection and shortening in three cases. While, lengthening was performed in all cases, deformities were corrected in nine cases. The union rate was achieved in 58.3% with one treatment and 91.7% with two treatments with a mean follow up of 3.5 years [range 1.5 to 5.5 years]. Complications were four refractures and three residual deformities