Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature

Volume 7 | Issue 2 | May-August 2021 | Page: 20-23 | Ferdinand Nyankoue Mebouinz, Serge Etoundi Bekoé, Rose Bengono, Bertine Manuela Ndjeunga, Cathy Bebey Engome, Fabrice Arroye Betou

Authors: Ferdinand Nyankoue Mebouinz [1], Serge Etoundi Bekoé [1], Rose Bengono [1], Bertine Manuela Ndjeunga [2], Cathy Bebey Engome [3], Fabrice Arroye Betou [4]

[1] Department of Orthopaedic Trauma Surgery, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[2] Obstetrics Gynecology Clinic, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[3] Albert Royer Children’s Hospital University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar,Senegal.
[4] Department of Cardiovascular and Thoracic Surgery, University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar, Senegal.

Address of Correspondence
Dr Ferdinand Nyankoue Mebouinz,
Estrada do Forte do Alto Duque, 1449-005, Lisbon.
E-mail: ferdinandmebouinz@gmail.com

Abstract

Background: Diagnosed and treated fairly early, children’s septic arthritis of the hip has few or no complications. Septic epiphyseal detachment of the hip in children is a rare complication due to delayed treatment. Unilateral forms have been reported, but bilateral involvement has never been described in the literature.
Case presentation: We report the case of an 8-year-old girl who presented with hip pain associated fever and diminished lower limb movements, approximately 4 months after the onset of symptoms. The diagnosis of bilateral septic epiphyseal detachment of the hips was made and computerized tomography (CT) scan revealed osteonecrosis of both femoral heads. The necrotic epiphyses required removal in order to control the infection.
Conclusion: This report highlights the importance of early diagnosis of septic arthritis of the hip in the neonatal period. Any delay in presentation, diagnosis or management can result in irrecoverable sequelae for the developing hip and seriously impact long-term function.
Keywords: Septic arthritis, Bilateral, Epiphysis detachment, Hip, Ablation.

References

1. Barthes X, Safar A, Seringe R. Treatment of septic arthritis in children. Arch Pediatr. 1 mai 1997;4(5):460‑3.
2. Badgley CE, Yglesias L, Perham WS, Snyder CH. STUDY OF THE END RESULTS IN 113 CASES OF SEPTIC HIPS. JBJS. Oct 1936; 18(4):1047.
3. Siffert RS. The Effect of Juxta-epiphyseal Pyogenic Infection on Epiphyseal Growth. Clin Orthop Relat Res. Oct 1957; 10:131.
4. Teklali Y, Ettayebi F, Benhammou M, El Alami ZF, El Madhi T, Gourinda H, et al.
Septic arthritis in infants and children about 554 cases. J Pediatrics and Childcare. 2002;15(3):137‑41. https://doi.org/10.1016/S0987-7983(02)83036-5
5. Coulibaly Y, Diakite AA, Keita M, Diakite I, Dembele M, Diallo G. Epidemiology and therapy of osteoarthritis in children. Mali Med. 2009; 24(3):7–10.
6. Aroojis AJ, Johari AN. Epiphyseal Separations After Neonatal Osteomyelitis and Septic Arthritis, Journal of Pediatric Orthopaedics. July 2000; 20(4):544.
7. Wyers MR, Samet JD, Mithal LB. Physeal separation in pediatric osteomyelitis. Pediatr Radiol. 2019;49:1229-33. https://doi.org/10.1007/s00247-019-04410-8.
8. Gajdobranski D, Petković L, Komarcević A, Tatić M, Marić D, Pajić M. [Septic arthritis in neonates and infants]. Med Pregl. June 2003; 56(5‑6):269‑75.
9. Mue DD, Salihu MN, Yongu WT, Ochoga M, Kortor JN, Elachi IC. Paediatric Septic Arthritis in a Nigerian Tertiary Hospital: A 5-Year Clinical Review. West Afr J Med. Aug 2018; 35(2):70‑4.
10. Atarraf K, Arroud M, Chater L, Afifi MA. Post-infectious femoral epiphysis detachment, about two cases. Pan Afr Med J. Aug 2014; 18:319. https://doi: 10.11604/pamj.2014.18.319.2242.
11. Schiavon R, Borgo A, Micaglio A. Septic physeal separation of proximal femur in a newborn. J Orthop Traumatol. Jun 2009; 10(2):105‑10.
12. Singh D, Krishna LG, Siddalingaswamy MK, Gupta V. Extra capsular extrusion of femoral capital epiphysis – an unusual presentation of sequelae of septic arthritis of hip. J Pediatr Orthop Part B. Nov 2011; 20(6):428‑31.
13. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005;41(1‑2):59‑62.https://doi.org/10.1111/j.1440-1754.2005.00538.x
14. RAMSEYER P, CAHUZAC JP. Acute osteo-articular infection of limbs in children. Rev Prat. 2001; 9:337‑45.
15. Rasigade J-P, Trouillet-Assant S, Laurent F. Staphylococcal bone and joint infections.Rev Francoph Lab. 2016;2016(480):33‑40. http://doi.org/10.1016/S1773-035X(16)30085-5
16. Sferopoulos NK, Papavasiliou VA. [Proximal epiphyseal separation of the femur in the newborn: early ultrasonic diagnosis]. Revue de Chirurgie Orthopedique et Reparatrice de L’appareil Moteur. 1994 ;80(4):338-341.
17. Laine JC, Denning JR, Riccio AI, Jo C, Joglar JM, Wimberly RL. The use of ultrasound in the management of septic arthritis of the hip. J Pediatr Orthop Part B. 2015;24(2):95‑8.
18. Le Saux N. Diagnosis and management of acute osteoarticular infections in children. Paediatr Child Health. 18 jul 2018;23(5):344‑52.
19. Akakpo-Numado GK, Gnassingbe K, Songne B, Amadou A, Tekou H. [Hip septic arthritis in young children with sickle-cell disease]. Revue de Chirurgie Orthopedique et Reparatrice de L’appareil Moteur. Feb 2008; 94(1):58‑63. http://doi.org/10.1016/j.rco.2007.09.004
20. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O. Treatment of septic arthritis of the hip in children and adolescents. Orthopeadic Trauma Surgery. Dec 2013; 151 (6):596‑602.
21. Seivert V, Milin L, Coudane H, Delagoutte J-P, Martrille L. Medical conditions and arthroscopy Osteoarthritis, osteochondromatosis, synovitis septic and rheumatologic arthritis. In: Hulet C, Flurin P-H, editors. Arthroscopic Technics of Upper Limb. Paris: Elsevier Masson; 2013 p. 153‑63.
22. Daffe M, Sarr L, Gueye AB, Dembele B, Diouf AB, Sane A, et al. Hip Septic Arthritis: A Rare Complication. Int J Paediatr Orthop. 2019; 5(1):25‑6.
23. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthritis of the hip in infants. JBJS. 1990; 72(8):1150‑65.
24. Hunka L, Said SE, MacKenzie DA, Rogala EJ, Cruess RL. Classification and surgical management of the severe sequelae of septic hips in children. Clin Orthop Relat Res. 1982;171:30‑6.
25. Choi IH, Shin YW, Chung CY, Cho T-J, Yoo WJ, Lee DY. Surgical treatment of the severe sequelae of infantile septic arthritis of the hip. Clin Orthop. 2005; (434):102‑9.

How to Cite this Article:  Mebouinz FN, Bekoé SE, Bengono R, Ndjeunga BM, Engome CB, Betou FA | Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 20-23.

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Mitten deformity

Volume 7 | Issue 1 | January-April 2021 | Page: 27 | Yashdeep Singh Pathania

Authors: Yashdeep Singh Pathania MD [1]

[1] Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur 342005, India.

Address of Correspondence
Dr. Yashdeep Singh Pathania
Senior Resident, Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur 342005, India.
Email: yashdeepsinghpathania@gmail.com

A 10-year-old boy, a known case of severe recessive dystrophic epidermolysis bullosa since childhood, presented with widespread scarring over scalp, face, upper and lower limbs. Hands and feet showed flexion contracture, anonychia. There was fusion of digits of the feet by a thin membrane of scar tissue producing pseudosyndactyly, known as mitten deformity (Figure 1). In pseudosyndactyly, digits are fused together by thin membrane and involve only the distal portion of digits, which can be released through surgery where as in syndactyly actual and complete fusion of digits occur and involve base of the digits.

Figure: Scarring over legs with flexion contracture and pseudosyndactyly of foot.

 

How to Cite this Article:  Singh Pathania Y  | Mitten deformity | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 27.

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Horizontal Intra-articular dislocation of patella with intact periosteal sleeve in an adolescent: Case report and review of literature

Volume 7 | Issue 1 | January-April 2021 | Page: 22-26 | Mudit Shah, Amin Shah, Mandar Agashe

Authors: Mudit Shah MBBS, MS Ortho. [1], Amin Shah MBBS, MS Ortho.[2], Mandar Agashe MBBS, MS Ortho.[3]

[1] Director and CEO, Sapna Healthcare centre, Ghatkopar west, Mumbai, Maharashtra, India.
[2] Fellow of Paediatric Orthopaedic, Dr. Agashe`s Maternity & Surgical Nursing Home, Kurla west, Mumbai, Maharashtra, India Mumbai, Maharashtra, India.
[3] Consultant paediatric Orthopaedic surgeon, Dr. Agashe`s Maternity & Surgical Nursing Home, Kurla west, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Mandar Agashe,
Consultant paediatric Orthopaedic surgeon, Dr. Agashe`s Maternity & Surgical Nursing Home, Kurla west, Mumbai, Maharashtra, India.
E-mail: mandarortho@gmail.com

Abstract

Intra-articular patella dislocations are uncommon, but the majority of cases can be reduced by closed methods. We present a rare case that required open reduction and highlight the reasons and present a review of the same.
We describe a rare case of horizontal intra-articular patella dislocation associated with an intact periosteal sleeve and extensor retinaculum in a 13-year-old boy requiring open reduction.
Horizontal intra-articular patellar dislocation is an uncommon injury, especially in the adolescent age group. Open reduction should only be performed if closed reduction is unsuccessful.
Keywords: Horizontal intra-articular dislocation of patella, Intact periosteal sleeve, Open reduction.

References 

1. Pagdal S, Lande O, Jadhav U. Intra-articular dislocation of patella reduced by closed method – A rare case report. J Clin Orthop trauma [Internet]. 2016;7(Suppl 1):118–20. Available from: http://dx.doi.org/10.1016/j.jcot.2016.03.002.
2. Uluyardımcı E, Bozkurt İ, Öçgüder DA, Yalçın N. Unusual Horizontal Patellar Dislocation Reduced without General Anesthesia. JBJS Case Connect [Internet]. 2019 Jan;9(1):e2. Available from: http://insights.ovid.com/crossref an=01709767-201903000-00003.
3. Rangdal S, Bachhal V, Vashisht S, Dhillon MS. Intra-articular dislocation of the patella: a rare variant to an uncommon injury. BMJ Case Rep [Internet]. 2019 Apr 24;12(4). Available from: http://www.ncbi.nlm.nih.gov/pubmed/31023730.
4. Shaw DL, Giannoudis P V., Archer IA. Intra-articular dislocation of patella. Injury [Internet]. 1995 May;26(4):273–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7649634.
5. Bashir S, Manan A, Wani D, Tantray O, Beigh M, Sharma R. Bilateral intra-articular dislocation of patella in an elderly: a rare presentation. Internet J Orthop Surg. 2010;19(1).
6. Fithian DC, Paxton EW, Stone M Lou, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med [Internet]. 32(5):1114–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15262631.
7. Kramer DE, Simoni MK. Horizontal intra-articular patellar dislocation resulting in quadriceps avulsion and medial patellofemoral ligament tear: a case report. J Pediatr Orthop B [Internet]. 2013 Jul;22(4):329–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22828187.
8. Tsai C-H, Hsu C-J, Hung C-H, Hsu H-C. Primary traumatic patellar dislocation. J Orthop Surg Res [Internet]. 2012;7(1):21. Available from: http://josr-online.biomedcentral.com/articles/10.1186/1749-799X-7-21.
9. Venkatesh Gupta SK, H P P, Prathik R, Jeetesh L. Traumatic Intra-articular Intercondylar Dislocation of the Patella Reduced by the Closed Method with Open Quadriceps Repair in an Adolescent: A Rare Case Report. Cureus [Internet]. 2018 Dec 8; Available from: https://www.cureus.com/articles/14706-traumatic-intra-articular-intercondylar-dislocation-of-the-patella-reduced-by-the-closed-method-with-open-quadriceps-repair-in-an-adolescent-a-rare-case-report.
10. McHugh G, Ryan E, Cleary M, Kenny P, O’Flanagan S, Keogh P. Intra-Articular Dislocation of the Patella. Case Rep Orthop [Internet]. 2013;2013:1–3. Available from: http://www.hindawi.com/journals/crior/2013/535803/
11. Al Khalifa A, Syed K. Intra-articular dislocation of patella with femoral impaction—A case report and review of literature. Int J Surg Case Rep [Internet]. 2019;59:176–9. Available from: https://doi.org/10.1016/j.ijscr.2019.05.041.
12. van den Broek TAA, Moil PJ. Horizontal rotation of the patella: A case report with review of the literature. Acta Orthop Scand [Internet]. 1985 Jan 8;56(5):436–8. Available from: http://www.tandfonline.com/doi/full/10.3109/17453678508994367.
13. Berenger V, Pesenti S, Ollivier M, Buord J-M, Pinelli P-O. Traumatic inter-condylar dislocation of the patella: Report of two cases. Orthop Traumatol Surg Res [Internet]. 2013 Dec;99(8):979–81. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1877056813002077.
14. Potini VC, Gehrmann RM. Intra-Articular Dislocation of the Patella With Associated Hoffa Fracture in a Skeletally Immature Patient. Am J Orthop (Belle Mead NJ) [Internet]. 2015 Jun;44(6):E195-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26047005.

How to Cite this Article:  Shah M, Shah A, Agashe M  | Horizontal Intra-articular dislocation of patella with intact periosteal sleeve in an adolescent: Case report and review of literature | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 22-26.

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Elbow, Forearm and Wrist Issues in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 55-64 | Praveen Bhardwaj, Darshan Kumar A Jain, Maulin M Shah, Rujuta Mehta, Badarinath Athani

Authors: Praveen Bhardwaj MS Ortho., DNB Ortho. FNB [1], Darshan Kumar A Jain MS Ortho., FNB [2],
Maulin M Shah MS Ortho. [3], Rujuta Mehta MS Ortho. DNB Ortho. [4], Badarinath Athani MS Ortho., DNB (PMR) [5]

[1] Consultant Hand and Reconstructive Microsurgeon, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[2] Consultant Hand and Reconstructive Microsurgeon. Ramaiah Hospitals, Bangalore, Karnataka, India.
[3] Consultant Paediatric Orthopaedic Surgeon, Orthokids Clinic, Ahmedabad, Gujarat, India.
[4] HOD Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
[5] Principle consultant Safdarjung Hospital, Vardhaman Mahavir Medical College, New Delhi, India.

Address of Correspondence
Dr. Praveen Bhardwaj ,
Consultant Hand and Reconstructive Microsurgeon, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: drpb23@gmail.com

Abstract

The variable presentation of the sequelae of brachial plexus birth palsy (BPBP) at the elbow, forearm and wrist and their association with much extensive brachial plexus involvement makes reconstruction at these levels demanding . Functional limitation and cosmetic concern are common indications for surgical intervention. This article presents a synopsis of the incidence, pathogenesis, clinical presentation and parental concerns related to these deformities, decision-making considerations, management strategies and expected outcome for correction of these deformities. Deformities at the forearm and wrist can be often corrected simultaneously as they could be interrelated. The pattern of deformities, their severity and their impact on the overall function of the limb and parental concern differ. Each child needs a tailor-made management plan, weighing the expected outcome against parental expectation.
Keywords: Brachial plexus birth palsy, Forearm deformity, Supination deformity, Elbow flexion deformity, Pronation deformity, Ulnar deviation deformity.

References 

1. Venkatramani H, Bhardwaj P, Sabapathy SR. Birth Brachial Plexus Palsy. In: Agarwal K. ed. Text book of Plastic & Reconstructive & Aesthetic Surgery. (Chapter 29) Vol 2. First edition Delhi: Thieme, 2017: p 665-695.
2. Sebastin SJ, Chung KC. Reconstructive strategy for recovery ofhand function. In: Chung KC, Yang LJS, McGillicuddy JE, eds.Practical Management of Pediatric and Adult Brachial Plexus Palsies. New York, NY: Elsevier Saunders; 2012:114–142
3. Nath RK, Somasundaram C, Melcher SE, Bala M, Wentz MJ. Arm rotated medially with supination – the ARMS variant: description of its surgical correction. BMC MusculoskeletDisord. 2009; 10:32.
4. Bhardwaj P, Venkatramani H, Sabpathy SR. Elbow flexion deformity in birth brachial plexus palsy. Presented at- Asia Pacific Hand Surgery Meet at Melbourne, March 2020. https://apfssh2020.org/downloads/APFSSH-APFSHT-Program-&-Abstract-Book.pdf
5. Nikolaou S, Hu L, Cornwall R. Afferent Innervation, Muscle Spindles, and Contractures Following Neonatal Brachial Plexus Injury in a Mouse Model. J Hand Surg Am2015; 40:2007-16.
6. Nikolaou S, Peterson E, Kim A, Wylie C, Cornwall R. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury. J Bone Joint Surg Am. 2011;93(5):461e470.
7. van der Sluijs JA, van der Sluijs MJ, van de Bunt F, van Ouwerkerk WJR. What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury. J Child Orthop. 2018;12(5):544-549.
8. Sheffler LC, Lattanza L, Hagar Y, Bagley A, James MA. The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy. J Bone Joint Surg Am 2012;94(5):403–409.
9. Al-Qattan MM. Total obstetric brachial plexus palsy in children with internal rotation contracture of the shoulder, flexion contracture of the elbow, and poor hand function. Ann PlastSurg2010; 65:38-42.
10. Sheffler LC, Lattanza L, Sison-Williamson M, James MA. Biceps brachii long head overactivity associated with elbow flexion contracture in brachial plexus birth palsy. J Bone Joint Surg Am. 2012;94(4):289-297.
11. Ho ES, Roy T, Stephens D, Clarke HM. Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy. J Hand Surg Am. 2010;35(1):84-91.
12. Nath RK, Somasundaram C. Biceps Tendon Lengthening Surgery for Failed Serial Casting Patients with Elbow Flexion Contractures Following Brachial Plexus Birth Injury. Eplasty. 2016;16: e24.
13. Vekris MD, Pafilas D, Lykissas MG, Soucacos PN, Beris AE. Correction of elbow flexion contracture in late obstetric brachial plexus palsy through arthrodiatasis of the elbow (Ioannina method). Tech Hand Up Extrem Surg. 2010;14(1):14-20. doi:10.1097/BTH.0b013e3181c848cb
14. Bhardwaj P, Venkatramani H, Sabpathy SR. Forearm deformities in birth brachial plexus palsy- Deformity profile and correction strategy. Presented at- Asia Pacific Hand Surgery Meet at Melbourne, March 2020. https://apfssh2020.org/downloads/APFSSH-APFSHT-Program-&-Abstract-Book.pdf| 12APFSSH/8APFSHT [Internet]. [cited 2020 Aug 18]. Available from: https://apfssh2020.org/program-wednesday.php
15. Allende CA, Gilbert A. Forearm supination deformity after obstetric paralysis. Clin OrthopRelat Res. 2004;(426):206-211.
16. Yam A, Fullilove S, Sinisi M, Fox M. The supination deformity and associated deformities of the upper limb in severe birth lesions of the brachial plexus. J Bone Joint Surg Br. 2009;91(4):511-516.
17. Zancolli EA II. Palliative surgery: pronosupination in obstetricpalsy. In: Gilbert A, ed. Brachial Plexus Injuries. London, UK:Martin Dunitz; 2001:275–29.
18. Al-Qattan MM, Al-Khawashki H. The “beggar’s” hand and the “unshakable” hand in children with total obstetric brachial plexus palsy. PlastReconstrSurg 2002;109(6):1947–1952
19. Zancolli, EA. Paralytic supination contracture of the forearm. J Bone Joint Surg Am. 1967, 49: 1275–84
20. Kozin, SH. Treatment of the supination deformity in the pediatric brachial plexus patient. Tech Hand Up Extrem Surg. 2006, 10: 87–95
21. Hankins SM, Bezwada HP, Kozin SH. Corrective osteotomies of the radius and ulna for supination contracture of the pediatric and adolescent forearm secondary to neurologic injury. J Hand Surg Am. 2006;31(1):118-124.
22. Manske, PR, McCarroll, HR, Hale, R. Biceps tendon rerouting and percutaneous osteoclasis in the treatment of supination deformity in obstetrical palsy. J Hand Surg Am. 1980, 5:153–9.
23. Lipskeir E, Weizenbluth M. Derotation osteotomy of the forearm in management of paralytic supination deformity. J Hand Surg Am. 1993;18(6):1069-1074.
24. Ozkan T, Aydin A, Ozer K, Ozturk K, Durmaz H, OzkanS. A surgical technique for pediatric forearm pronation:brachioradialis rerouting with interosseous membrane release.
J Hand Surg Am 2004;29(1):22–27.
25. Soucacos, Panayotis&Vekris, Marios& Kostas, John & Johnson, Elizabeth. Secondary Reconstructive Procedures in Obstetrical Brachial Plexus Palsy: Forearm, Wrist, and Hand Deformities. Semin Plast Surg. 2005;19(01):96–102.
26. Anderson GA, Thomas BP, Pallapati SC. Flexor carpi ulnaris tendon transfer to the split brachioradialis tendon to restore supination in paralytic forearms. J Bone Joint Surg Br. 2010;92(2):230-234.
27. Ozkan T, Tuncer S, Aydin A, Hosbay Z, Gulgonen A. Brachioradialis re-routing for the restoration of active supination and correction of forearm pronation deformity in cerebral palsy. J Hand Surg Br. 2004;29(3):265-270.
28. Amrani A, Dendane MA, El Alami ZF. Pronator teres transfer to correct pronation deformity of the forearm after an obstetrical brachial plexus injury. J Bone Joint Surg Br.2009;91(5):616-618.
29. Cheema, TA, Firoozbakhsh, K, De Carvalho, AF, Mercer, D. Biomechanic comparison of 3 tendon transfers for supination of the forearm. J Hand Surg Am. 2006, 31: 1640–4.
30. Al-Qattan MM, El-Sayed AA, Al-Zahrani AY, et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol. 2009;34(6):788-791.
31. Chuang DC, Ma HS, Borud LJ, Chen HC. Surgical strategy for improving forearm and hand function in late obstetric brachial plexus palsy. PlastReconstr Surg. 2002; 109:1934–1946.
32. Bhardwaj P, Parekh H, Venkatramani H, Raja Sabapathy S. Surgical correction of ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy sequelae. Hand Surg. 2015;20(1):161-165.
33. Ozkan T, Aydin HU, BerkozO, Ozkan S, Kozanoglu E. ‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy. J Hand Surg Eur Vol. 2019;44(9):905-912.
34. Duclos L, Gilbert A. Restoration of wrist extension by tendon transfer in cases of obstetrical brachial plexus palsy. Ann Chir Main Memb Super. 1999; 18:7–12.
35. Bertelli JA. Brachialis muscle transfer to the forearm muscles in obstetric brachial plexus palsy. J Hand Surg Br 2006; 31:261–5.
36. Boulahouache A, Cambon-Binder A, Chouiha M, Lardjane ML, Belkheyar Z. Chondrodesis of the wrist in children with severe paralytic hand deformities. Hand SurgRehabil. 2020;39(4):251-255.

How to Cite this Article:  Bhardwaj P, Jain DA, Shah MM, Mehta R, Athani B | Elbow, Forearm and Wrist Issues in Brachial Plexus Birth Palsy: Current Concepts | International Journal of Paediatric
Orthopaedics | January-April 2021; 7(1): 55-64.

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Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 45-54 | Rujuta Mehta, Qaisur Rabbi, Praveen Bhardwaj, Maulin M. Shah, Dhiren Ganjwala

Authors: Rujuta Mehta MS Ortho. DNB Ortho. [1], Qaisur Rabbi MBBS, DNB Ortho. [2],
Praveen Bhardwaj MS Orth., DNB Ortho. FNB [3], Maulin M. Shah MS Ortho. [4], Dhiren Ganjwala MS Ortho. [5]

[1] Department of Orthopaedics, HOD Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
[2] Department of Paediatric Orthopaedic Surgery, Center for the Rehabilitation of the Paralysed, CRPBangladesh.
[3] Department of Orthopaedics, Consultant Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[4] Department of Paediatric Orthopaedic Surgery, Orthokids Clinic, Ahmedabad
[5] Ganjwala Orthopedic Hospital, Ahmedabad, Gujrat, India.

Address of Correspondence
Dr. Rujuta Mehta,
HOD Bai Jerbai Wadia Hospital for Children, Consultant Paediatric Orthopedic and Paediatric
Upper Limb Surgeon- Nanavati Superspeciality Hospital, Jaslok Hospital and Shushrusha Hospital.
E-mail: rujutabos@gmail.com

Abstract

Shoulder dysplasia is common constituting 80% of sequelae secondary to BPBP. Muscle imbalance due to uninhibited co-contractions and eccentric forces across the shoulder joint are the main causes of shoulder sequelae. This leads to limitation of shoulder movements and gleno-humeral deformity. This article discusses the presentations, investigations and treatment approach to various severities of deformities resulting from the muscular imbalance about the shoulder in BPBP.

Keywords: Shoulder sequelae, Rebalancing conjoint transfer, Salvage surgery.

References 

1) Waters PM, Smith GR, Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am. 1998; 80(5): 668-77.
2)M L Pearl, B W Edgerton. Glenoid deformity secondary to brachial plexus birth palsy J Bone Joint Surg Am. 1998 May;80(5):659-67. doi: 10.2106/00004623-199805000-00006.
3)Susan V Duff, Sudarshan Dayanidhi, Scott H Kozin. Asymmetrical shoulder kinematics in children with brachial plexus birth palsy. Clin Biomech (Bristol, Avon). 2007 Jul; 22(6):630-8. doi: 10.1016/j.clinbiomech.2007.02.002.
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How to Cite this Article:  Mehta R, Rabbi Q, Bhardwaj P, Shah MM, Ganjwala D | Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 45-54.

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Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 37-44 | Parag B. Lad, Nischal Naik, Bharat K. Kadadi, P. S. Bhandari, Mukund R. Thatte

Authors: Parag B. Lad D Ortho., MS Ortho. [1], Nischal Naik M.Ch. [2], Bharat K. Kadadi MS Ortho. [3],
P. S. Bhandari M.Ch. [4], Mukund R. Thatte M.Ch. [5]

[1] Jupiter Hospital, Thane, Maharashtra, India.
[2] Divyam Hospital, Ahmedabad, Gujarat, India.
[3] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.
[4] Brij Lal Super specialty Hospital, Haldwani, Nainital, Uttarakhand, India.
[5] Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Mukund R Thatte,
Plastic Surgeon, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
E-mail: mthatte@gmail.com

Abstract

This article discusses the role of primary nerve surgery for Brachial Plexus Birth Palsy (BPBP). Spontaneous recovery in brachial plexus birth palsy is known and in such cases the prognosis is good. However, the incidence of such recovery is 30 – 90%. In some infants however, the course of motor recovery is inadequate necessitating nerve repair. BPBP presents clinically as a lower motor neuron type of upper limb monoplegia at birth. Indications of primary nerve reconstruction or distal nerve transfer, the technique of exploration of brachial plexus, common anatomical variations and the methods for identification of intact roots are discussed in detail.
Keywords: Primary nerve reconstruction, Brachial Plexus Birth Palsy (BPBP), Nerve transfer, co-contractions, Brachial plexus surgery.

References 

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How to Cite this Article:  Lad PB, Naik N, Kadadi BK, Bhandari PS, Thatte MR | Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 37-44.

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