Abstract
Purpose
Obstetric brachial plexus palsy (OBPP) may result in a severe impairment of upper limb function, especially when major motor functions do not recover with or without early microsurgical reconstruction. Various methods to restore elbow flexion have been described. The aim of this study was to report the results after pectoralis minor transfer for elbow flexion restoration in late OBPP.
Methods
Nineteen patients were included. Mean age at surgery was six years (range, 2.3–12.8). The mean follow-up period was four years (range, 1–15). Shoulder function was evaluated by the Mallet classification and hand function by the Raimondi scale. We used the “active movement scale” (AMS) to evaluate elbow flexion function.
Results
Eighteen of the 19 patients had improvement in their elbow active flexion. There was significant improvement in biceps muscle power according to the BMRC grading system, from an average grading of 1.7 (range, 1–3) pre-operatively to 3 (range, 1–4) post-operatively (P < 0.05). The average active elbow flexion was significantly improved from a mean of 81° (range, 0–120; SD = 44) pre-operatively, most of them gravity eliminated, to a mean of 111° (range, 0–140; SD = 33) post-operatively (P < 0.05). According to the AMS, 12 patients (63%) had a good result, 4 (21%) a fair result and 5 (26%) a poor result. Poor results were significantly correlated with a low pre-operative AMS score (P < 0.05).
Conclusions
The pectoral minor transfer can be a reliable technique for elbow flexion improvement in late OBPP by strengthening an already existing but inadequate active flexion.
Level of evidence: IV
Similar content being viewed by others
References
Gilbert A, Pivato G, Kheiralla T (2006) Long-term results of primary repair of brachial plexus lesions in children. Microsurgery 26:334–342
Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal elbow motion. J Bone Joint Surg Am 63:872–877
Al-Qattan MM (2002) Oberlin’s ulnar nerve transfer to the biceps nerve in Erb’s birth palsy. Plast Reconstr Surg 109:405–407
Van Egmond C, Tonino AJ, Kortleve JW (2001) Steindler flexorplasty of the elbow in obstetric brachial plexus injuries. J Pediatr Orthop 21:169–173
Al-Qattan MM (2005) Elbow flexion reconstruction by Steindler flexorplasty in obstetric brachial plexus palsy. J Hand Surg (Br) 30:424–427
Atkins RM, Bell MJ, Sharrard WJ (1985) Pectoralis major transfer for paralysis of elbow flexion in children. J Bone Joint Surg (Br) 67:640–644
Rostoucher P, Alnot JY, Touam C, Oberlin C (1998) Tendon transfers to restore elbow flexion after traumatic paralysis of the brachial plexus in adults. Int Orthop 22:255–262
Zancolli E, Mitre H (1973) Latissimus dorsi transfer to restore elbow flexion. An appraisal of eight cases. J Bone Joint Surg Am 55:1265–1275
Hoang PH, Mills C, Burke FD (1989) Triceps to biceps transfer for established brachial plexus palsy. J Bone Joint Surg (Br) 71:268–271
Le Coeur (1953) Procedures for restoration of function of paralytic elbow. Rev Chir Orthop Reparatrice Appar Mot 39:655–656
Curtis C, Stephens D, Clarke HM, Andrews D (2002) The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg [Am] 27:470–478
Terzis JK, Kokkalis ZT (2010) Secondary procedures for elbow flexion restoration in late obstetric brachial plexus palsy. Hand (NY) 5(2):125–134
Scevola S, Cowan J, Harrison DH (2003) Does the removal of pectoralis minor impair the function of pectoralis major? Plast Reconstr Surg 112:1266–1273
Spira E (1957) Replacement of biceps brachii by pectoralis minor transplant. J Bone Joint Surg (Br) 39-B(1):126–127
Ho ES, Curtis CG, Clarke HM (2012) The brachial plexus outcome measure: development, internal consistency, and construct validity. J Hand Ther 25:406–417
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Additional information
This work was performed at Trousseau Hospital and at Robert Debre Hospital, Paris, France.
Rights and permissions
About this article
Cite this article
Costil, V., Romana, C. & Fitoussi, F. Pectoralis minor transfer for elbow flexion restoration in late obstetric brachial plexus palsy. International Orthopaedics (SICOT) 42, 1137–1141 (2018). https://doi.org/10.1007/s00264-017-3725-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-017-3725-6