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Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study

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Abstract

Purpose

The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy.

Methods

Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores. Clinical outcomes were collected at three time intervals: pre-operatively, one-year post-operative and at latest follow-up.

Results

After exclusion, 21 patients remained for further analysis. Mean age at surgery was 3.7 years (range, 1.2–8.7), and mean follow-up length was 6.5 years (2.9–9.7). Moderate improvements were found for mean Mallet score, active external rotation, active abduction and hand-to-mouth movement at one year and latest follow-up. However, improvements in active external rotation and Mallet score were not fully maintained at final follow up.

Conclusion

Isolated subscapularis Z-lengthening is effective at early follow-up, but results are not maintained at mid-term follow-up.

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Acknowledgments

We kindly thank Evelyn Lidsay for her artwork.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK

    Anne Sophie Kruit, Fouzia Choukairi, Anuj Mishra & Andrea Jester

  2. Department of Orthopaedic Surgery, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK

    Andrew Gaffey

  3. Wijde Begijnestraat 5, 3512 AW, Utrecht, The Netherlands

    Anne Sophie Kruit

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  1. Anne Sophie Kruit
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  2. Fouzia Choukairi
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  3. Anuj Mishra
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  4. Andrew Gaffey
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  5. Andrea Jester
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Correspondence to Anne Sophie Kruit.

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The authors declare no conflicts of interest.

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No funding of any kind was received for this work from any organisation.

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Kruit, A.S., Choukairi, F., Mishra, A. et al. Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study. International Orthopaedics (SICOT) 40, 783–790 (2016). https://doi.org/10.1007/s00264-015-3062-6

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  • DOI: https://doi.org/10.1007/s00264-015-3062-6

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