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Surgical Soft Tissue Management for Glenohumeral Deformity and Contractures in Brachial Plexus Birth Injury

A Systematic Review and Meta-analysis

  • Outcomes in Research in Orthopedics (O Ayeni, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of the Review

Consensus on the effects of soft tissue surgical intervention in the management of brachial plexus birth injury (BPBI) sequalae is lacking. The purpose of this review is to examine the available literature on the functional and structural outcomes following soft tissue surgical management of BPBI sequalae.

Recent Findings

EMBASE, PubMed, and MEDLINE were searched for related literature from the point of database inception until April 2021. Relevant papers were screened by two reviewers independently and in duplicate. A meta-analysis was performed using a random effects model. A total of 25 studies (852 patients) were included in the review, with the number included in each meta-analysis varying based on outcome of interest. There were significant improvements from pre- to post-operative time points for the following measures: Mallet aggregate scores (5.0 points, p<0.0001), active external rotation in adduction (48.9°, p=0.003), passive external rotation in adduction (64.6°, p< 0.00001), active abduction (46.2°, p<0.00001), glenoid version (14.4°, p< 0.00001), and percentage of the humeral head anterior to the scapular line (17.53°, p< 0.00001). Furthermore, data revealed an overall complication rate of 9.3% (79/852 patients) and a major complication rate of 0.47% (4/852 patients).

Summary

Patients with BPBI sequela experience statistically significant improvements in functional, structural, and range of motion outcomes of the GH joint following soft tissue surgical management. Understanding the ideal indications for each procedure and age of surgical management with future prospective studies will help to optimize surgical management of these patients.

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Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Sean R. McKellar

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Jeffrey Kay, Muzammil Memon, Nicole Simunovic, Waleed Kishta & Olufemi R. Ayeni

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McKellar, S.R., Kay, J., Memon, M. et al. Surgical Soft Tissue Management for Glenohumeral Deformity and Contractures in Brachial Plexus Birth Injury. Curr Rev Musculoskelet Med 15, 107–120 (2022). https://doi.org/10.1007/s12178-022-09747-6

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