Surgery about the elbow for brachial palsy.

The results of surgical procedures performed on 21 children to improve their elbow function were reviewed. Five flexor-plasties were performed in children with weak elbow flexors. In five patients with anterior dislocations of the radial head and supination contractures, transfers of the biceps to the ulna were performed. In eight patients with supination contractures and located radial heads, turnabout transfers to make the biceps a pronator were performed. Four of the five children with flexor-plasties had significant functional gains. All five biceps to ulna transfers had increased ability to flex without the necessity of supinating. The eight patients who had the turnabout procedure of the biceps had excellent flexion with the ability to pronate the forearm.

Closed reduction and tendon transfer for treatment of dislocation of the glenohumeral joint secondary to brachial plexus birth palsy.

Dislocation of the glenohumeral joint developed, in the first few years of life, in eight children who had brachial plexus birth palsy. The palsy involved the fifth and sixth cervical nerve roots in six children and the fifth, sixth, and seventh cervical nerve roots in two. All of the children had a release of the insertions of the pectoralis major, latissimus dorsi, and teres major followed by a closed reduction of the glenohumeral joint. The latissimus dorsi and the teres major were then transferred to the rotator cuff. All of the children had a well located glenohumeral joint with at least 25 degrees (mean, 51 degrees) of external rotation and at least 135 degrees (mean, 164 degrees) of abduction at the latest follow-up examination, at least two years postoperatively. Strength in abduction increased at least one grade, and strength in external rotation increased at least two grades. The improved motion and strength allowed the children to place the hands more effectively above the head and helped them to perform activities of daily living easily.

Latissimus dorsi and teres major transfer to rotator cuff for Erb's palsy.

During a 20-year period the authors operated on 56 patients with Erb's palsy to create active external rotation of the shoulder. Thirty-five patients had a follow-up period longer than 2 years (average 5 years), which allowed comparison with preoperative motion and strength. Preoperative passive external rotation averaged 5 degrees, whereas active abduction averaged 74 degrees. Preoperative external rotation strength was less than grade 2, whereas preoperative abduction strength was grade 2 or 3 in 33 of the 35 patients. Postoperative active external rotation averaged 31 degrees with only two recurrent internal rotation contractures. Postoperative active abduction averaged 120 degrees. Postoperative strength in external rotation increased in 29 of the 35 patients, with abduction strength increasing one or more grades in 13 of the 35 patients. Four complications occurred. Three patients continued to lose external rotation and required further surgical procedures, and a fourth had a superficial infection. This procedure compares well with the classic transfers to the proximal humerus in that it provides active external rotation in most cases and in some increases shoulder abduction strength.