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Review
. 2022 Apr;15(2):107-120.
doi: 10.1007/s12178-022-09747-6. Epub 2022 Feb 14.

Surgical Soft Tissue Management for Glenohumeral Deformity and Contractures in Brachial Plexus Birth Injury : A Systematic Review and Meta-analysis

Sean R McKellar  1 , Jeffrey Kay  2 , Muzammil Memon  2 , Nicole Simunovic  2 , Waleed Kishta  2 , Olufemi R Ayeni  3
Affiliations
Review

Surgical Soft Tissue Management for Glenohumeral Deformity and Contractures in Brachial Plexus Birth Injury : A Systematic Review and Meta-analysis

Sean R McKellar et al. Curr Rev Musculoskelet Med. 2022 Apr.

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). 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.

Keywords: Brachial plexus neuropathies; Orthopaedics; Shoulder joint.

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Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose. The authors declare they have no funding to disclose.

Figures

Figure 1
Figure 1
PRISMA flow diagram demonstrating the systematic review of the literature for the surgical management of soft tissues for glenohumeral deformity and contracture in brachial plexus birth injury
Figure 2
Figure 2
Forest plot of the mean difference (95% CI) in Mallet scores from pre- to post-operative
Figure 3
Figure 3
Forest plot of the mean difference (95% CI) in active ER with the arm in adduction from pre- to post-operation
Figure 4
Figure 4
Forest plot of the mean difference (95% CI) in passive ER with the arm in adduction from pre- to post-operative
Figure 5
Figure 5
Forest plot of the mean difference (95% CI) in active ABD from pre- to post-operative
Figure 6
Figure 6
Forest plot of the mean difference (95% CI) in PHHA measures from pre- to post-operative
See this image and copyright information in PMC

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