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The Results of Surgical Treatment of the Forearm Deformity in Perinatal Brachial Plexus Palsy

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Gosk J., Rutowski R., Urban M., Wiącek R., Wnukiewicz W., Mazurek P.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
610-614
EN
The aim of the study was the estimation of the results of surgical correction in pronation or supination forearm deformity.Material and methods. Clinical material comprised 19 patients, both sexes, in age from 2 years 3 months to 14 years who were treated in years 2001-2007 because of forearm deformation due to perinatal brachial plexus palsy. Evaluation of the results of surgical treatment has been performed in all cases with using Al-Qattan's scale.Results. As a result of performed tenomioplastic operations in all operated patients functional position of forearm has been achieved (grade 3 in Al-Qattan's scale)., and in 8 cases additionally good range of pronation and supination (grade 4 in Al-Qattan's scale).Conclusions. The necessity of forearm deformity correction in perinatal brachial plexus palsy may concern patients who have been treated microsurgically in very early childhood, and also patients who haven't been qualified to primary surgical treatment because of significant improvement of upper limb function as a result of rehabilitation. Tenomioplastic operations used in forearm position correction should be reserved for patients without fixed contracture who have possibility of forearm passive rotation moves. These procedures are burdened by low risk of complications and with proper qualification they can provide significant improvement of upper limb functional efficiency.
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The Results of Neurolysis In Perinatal Brachial Plexus Lesions Treatment

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Gosk J., Rutowski R., Wiâcek R., Urban M., Wnukiewicz W., Reichert P.
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EN
The aim of the study was to evaluate of the results of neurolysis in perinatal brachial plexus lesions treatment.Material and methods. Clinical material comprised 31 children, both sex, in age between 3 and 29 months, who had neurolysis of brachial plexus in period from 1998 to 2005. Treatment results have been evaluated in group of 26 children by commonly accepted scales. The shortest postoperative observation period lasted 4 years.Results. Good and very good function of shoulder after surgical treatment has been noted in 14 cases, good function of elbow has been noted in 21 cases. Advantageous position of forearm has been observed in 19 cases. Useful function of wrist in group of upper-middle and total lesions has been found in 18 examined children. Useful motor and sensory hand function has been observed in 7 from 11 examined children with total lesions.Conclusions. Significant compression of brachial plexus neural elements is an indication for their release (neurolysis) also in lesions which have been classified as a I and II degree in Sunderland's scale. In brachial plexus lesions with preserved macroscopic continuity of neural elements (after exclusion of avulsion lesions), intrafascicular fibrosis may be one of reasons of poor neural function improvement.
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