Document Detail


Meta-analysis of Function After Secondary Shoulder Surgery in Neonatal Brachial Plexus Palsy.
MedLine Citation:
PMID:  23872798     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Shoulder internal rotation contracture, active abduction, and external rotation deficits are common secondary problems in neonatal brachial plexus palsy (NBPP). Soft tissue shoulder operations are often utilized for treatment. The objective was to conduct a meta-analysis and systematic review analyzing the clinical outcomes of NBPP treated with a secondary soft-tissue shoulder operation.
METHODS:: A literature search identified studies of NBPP treated with a soft-tissue shoulder operation. A meta-analysis evaluated success rates for the aggregate Mallet score (≥4 point increase), global abduction score (≥1 point increase), and external rotation score (≥1 point increase) using the Mallet scale. Subgroup analysis was performed to assess these success rates when the author chose arthroscopic release technique versus open release technique with or without tendon transfer.
RESULTS:: Data from 17 studies and 405 patients were pooled for meta-analysis. The success rate for the global abduction score was significantly higher for the open technique (67.4%) relative to the arthroscopic technique (27.7%, P<0.0001). The success rates for the global abduction score were significantly different among sexes (P=0.01). The success rate for external rotation was not significantly different between the open (71.4%) and arthroscopic techniques (74.1%, P=0.86). No other variable was found to have significant impact on the external rotation outcomes. The success rate for the aggregate Mallet score was 57.9% for the open technique, a nonsignificant increase relative to the arthroscopic technique (53.5%, P=0.63). Data suggest a correlation between increasing age at the time of surgery and a decreasing likelihood of success with regards to aggregate Mallet with an odds ratio of 0.98 (P=0.04).
CONCLUSIONS:: Overall, the secondary soft-tissue shoulder operation is an effective treatment for improving shoulder function in NBPP in appropriately selected patients. The open technique had significantly higher success rates in improving global abduction. There were no significant differences in the success rates for improvement in the external rotation or aggregate Mallet score among these surgical techniques.
LEVEL OF EVIDENCE:: Level IV-meta-analysis.
Authors:
Emily J Louden; Chad A Broering; Charles T Mehlman; William C Lippert; Jesse Pratt; Eileen C King
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-17
Journal Detail:
Title:  Journal of pediatric orthopedics     Volume:  -     ISSN:  1539-2570     ISO Abbreviation:  J Pediatr Orthop     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-7-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8109053     Medline TA:  J Pediatr Orthop     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
†University of Cincinnati College of Medicine Divisions of *Pediatric Orthopaedic Surgery §Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH ‡St. George's University School of Medicine, University Centre Grenada, Grenada, West Indies.
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