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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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Perinatal brachial plexus palsy in children - etiology, classification and clinical picture of injuries

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Mielcarska M., Chochowska M., Zgorzalewicz-Stachowiak M.
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PL
Okoloporodowe uszkodzenie splotu ramiennego (o.u.s.r.) stanowi poważne powiklanie porodu. Schorzenie to występuje, według różnych szacunków, z częstością 0,20-5,1 na 1000 żywych urodzeń i jest wyższe w krajach o niższym statusie ekonomicznym. Do czynników etiologicznych pojawienia się o.u.s.r. należą: nieprawidlowo przebiegająca akcja porodowa, przebyte liczne ciąże, otylość i cukrzyca matki, a także dysproporcja główkowo-miedniczna pomiędzy matką i dzieckiem oraz ściśle z nią korelująca makrosomia dziecka (masa urodzeniowa ciała powyżej 4000 g). Zakres porażeń może być ograniczony do jednej kończyny górnej: prawej (65%) albo lewej (35%), lub w rzadkich przypadkach obu (5%). W zależności od anatomicznego miejsca uszkodzenia splotu wyróznia się typ: górny (Erba-Duchenna), środkowy, dolny (Dejanire-Klumpke), całkowity, mieszany i atypowy o.u.s.r. Kazdy z typów o.u.s.r ma charakterystyczną manifestację kliniczną (umiejscowienie niedowładów, zaburzenia troficzne itp.), która w dużym stopniu ułatwia postawienie rozpoznania. Trafna diagnoza jest warunkiem właściwego planowania leczenia fizjoterapeutycznego pacjenta z o.u.s.r., co ma zasadniczy wpływ na funkcjonalność porażonej kończyny i jakość życia chorego w przyszłości.
EN
Perinatal brachial plexus palsy (PBPP) is serious complication is a serious complication of labour. According to various sources this palsy occurs at a rate of 0.20-5.1 per 1000 neonates born alive and is higher in countries of lower economical status. The etiological factors influencing the occurrence of PBPP are as follows: abnormal labour, numerous pregnancies, obesity, diabetes and pelvicephalic disproportion between mother and child and macrosomia (child's weight above 4000 g). The palsy may affect either limb: right (65%) or left (35%) or seldom both (5%). Depending on the anatomical location of the plexus palsy, the following types have been distinguished: upper (Erb-Duchenna type), medial and lower (Dejanire-Klumpke type), complete, mixed and atypical. Each of the mentioned types has a characteristic clinical manifestations (location of paresis, trophic disorders, etc.), which significantly facilitate correct diagnosis. Accurate diagnosis is a condition for proper planning of physiotherapy of patients with PBPP. It has significant impact on the function of the affected limb and the future quality of life of the patients.
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