ABSTRACT
We describe the long-term results in ten patients with obstetric brachial plexus palsy of anterior shoulder release combined with transfer of teres major and latissimus dorsi posteriorly and laterally to allow them to act as external rotators. Eight patients had a lesion of the superior trunk and two some involvement of the entire brachial plexus. The mean age at operation was six years, and the mean follow-up was 30 years. Before operation, the patients were unable actively to rotate the arm externally beyond neutral, although this movement was passively normal. All showed decreased strength of the external rotator, but had normal strength of the internal rotator muscles. Radiologically, no severe bony changes were seen in the glenohumeral joint. No clinically detectable improvement of active abduction was noted in any patient. The mean active external rotation after operation was 36.5 degrees. This was maintained for a mean of ten years, and then deteriorated in eight patients. At the latest follow-up the mean active external rotation was 10.5 degrees. The early satisfactory results of the procedure were not maintained. In the long term there was loss of active external rotation, possibly because of gradual degeneration of the transferred muscles, contracture of the surrounding soft tissues and degenerative changes in the glenohumeral joint.
Subject(s)
Birth Injuries/complications , Brachial Plexus Neuropathies/surgery , Adult , Arm/physiopathology , Brachial Plexus Neuropathies/etiology , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Middle Aged , Muscle, Skeletal/transplantation , Orthopedic Procedures/methods , Patient Satisfaction , Postoperative Complications/etiology , Range of Motion, Articular/physiology , Rotation , Shoulder Joint/physiopathology , Treatment OutcomeABSTRACT
An eight and a half-year-old boy suffered from chronic osteomyelitis of the left ulna with sinuses, destruction of the middle three-quarters with the presence of necrotic bone and posterolateral dislocation of the radial head. The operative treatment included sequestrectomy and gradual reduction of the radial head after application of an Anderson apparatus. In a second procedure a corticocancellous tibial bone graft was used to bridge the ulnar gap, and later the redislocated radial head was excised. At the latest follow-up, 45 years postoperatively, the limb is fit with normal muscle strength and very satisfactory motion of the elbow and wrist joints, and the patient works as a hard manual laborer.
Subject(s)
Bone Transplantation , Osteomyelitis/complications , Plastic Surgery Procedures/methods , Radius/pathology , Ulna/surgery , Child , Elbow Joint/pathology , Elbow Joint/surgery , Humans , Male , Necrosis , Osteomyelitis/surgery , Osteotomy , Radius/surgery , Treatment OutcomeABSTRACT
We reviewed 42 patients who had had triple arthrodesis 25 years after surgery. The patients' age averaged 20 years. All patients had deformities due to poliomyelitis. They were satisfied with the operation, except for one patient. Good results were noted in 13, fair in 26, and poor in 3 cases. There was delayed wound healing in 8, superficial infection in 4, and avascular necrosis of the talus in 2 cases. There was no case of delayed union or nonunion. We found degenerative joint changes in 12 ankles and in 9 feet; fourteen patients experienced pain. In spite of these long-term changes, which appear acceptable, triple arthrodesis is a useful procedure for many deformities of the foot and can solve patients' problems for many years.
