Triangle tilt surgery as salvage procedure for failed shoulder surgery in obstetric brachial plexus injury

Abstract

Purpose: The study was conducted to review the effects of triangle tilt surgery in children with OBPI (obstetric brachial plexus injury) who had previously undergone several operative procedures at other hospitals before presenting at our institute.

Methods: The study included a group of 48 OBPI patients who had undergone previous operative procedures at outside hospitals by other surgeons. Patients were assessed for shoulder function using their radiological reports and the modified Mallet functional scale. The same patients underwent the triangle tilt procedure at our institution and were re-evaluated for shoulder function.

Results: The results of the study showed an increase in Mallet scores from 11.88 points to 15.17 points (p < 0.01), improvement in PHHA (percentage of humeral head anterior to the glenoid) from 14% to 25% (p < 0.05), enhancement in glenoid version from -32 degrees to -25 degrees (p < 0.01), and a decrease in the SHEAR (scapular hypoplasia, elevation, and rotation) deformity after surgery.

Conclusion: The data obtained demonstrated that the triangle tilt procedure significantly enhanced shoulder function and glenohumeral congruity in these patients as evidenced by the improvements in Mallet scores, PHHA, glenoid version, and SHEAR deformity.

Fig. 1

Axial computerized tomographic (CT) scans of the affected shoulder of an OBPI patient before and after triangle tilt surgery. a CT image before triangle tilt surgery showing posterior subluxation of the humeral head, measured by PHHA, and joint incongruity of the glenohumeral joint, measured by glenoid version. b Line diagram of the pre-triangle tilt CT image (a). c CT image after triangle tilt surgery showing improvement in PHHA and glenoid version. d Line diagram of the post-triangle tilt CT image (c) (Figure was prepared using the computer program Photoshop)

Fig. 2

Shoulder and arm functions in an OBPI patient before triangle tilt surgery but after humeral osteotomy by a highly experienced OBPI surgeon (a–c) and 21 months after triangle tilt surgery (d–f). Significant improvements were noticed in arm at rest, hand-to-mouth, and supination positions of the patient’s affected arm (right arm) (Figure was prepared using the computer program Photoshop)