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 

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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 

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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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26. Tse R, Kozin SH, Malessy MJ, Clarke HM. International Federation of Societies for Surgery of the Hand Committee report: the role of nerve transfers in the treatment of neonatal brachial plexus palsy. J Hand Surg Am. 2015;40(6):1246-1259.
27. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11(4):583-595.
28. Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent Horner’s syndrome in total obstetric brachial plexus injury. J Hand Surg Br. 2000;25(2):166-167.
29. Chen L, Gu YD, Hu SN, Xu JG, Xu L, Fu Y. Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children – a report of 12 cases. J Hand Surg Am. 2007;32(1):96-103.
30. Gilbert A. Results of repair to the obstetrical plexus. Brachial plexus injuries. London: Martin Duniz. 2001 Jun 21:211-5.

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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Clinical Examination and Early Management of Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 28-36 | Gaurav Gupta, Tejas Patel, Chasanal Rathod, Amila Shashanka Ratnayake, Maulin M Shah, Bharat K. Kadadi

Authors: Gaurav Gupta MBBS, MS Ortho. [1], Tejas Patel PT, C/NDT, SI. [2], Chasanal Rathod MBBS, MS Ortho. [3], Amila S. Ratnayake MBBS, MS MRCS(Ed) [4], Maulin M. Shah MBBS, MS Ortho. [5], Bharat K. Kadadi MBBS, MS Ortho. [6]

[1] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi
[2] Consultant, Paediatric Physiotherapist, Sparsh Paediatric Rehabilitation Clinic, Ahmedabad, Gujrat, India.
[3] Consultant Pediatric Orthopedic Surgeon, NHSRCC Children’s Hospital, Mumbai, Maharashtra, India.
[4] Plastic & Reconstructive Surgeon, National Hospital Kandy, Sri Lanka
[5] Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
[6] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Maulin M Shah,
Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
E-mail: maulinmshah@gmail.com

Abstract

Brachial Plexus Birth Palsy (BPBP) is defined as a flaccid paralysis of the upper limb that occurs as a result of traction injury to the brachial plexus during the process of birth. The incidence of BPBP has been estimated between 0.4% to 5.1% in various studies worldwide.
A precise clinical examination is the key to ascertain the type of injury, prognosticate the outcome and forecast the probable need of surgical intervention. A detailed clinical examination methodology and important signs directing to the intervention are described in this paper. The importance of regular clinical follow up has been emphasised. Early rehabilitation of infants with BPBP and physiotherapy protocols are discussed.

Keywords:

References 

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How to Cite this Article: Gupta G, Patel T, Rathod C, Ratnayake AS, Shah MM | Clinical examination and Early Management of Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 28-36.

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Factors affecting the outcome of Chronic Osteomyelitis in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 16-21 | Gaurav Gupta, Maulin M. Shah, Akash S. Makadia, Qaisur Rabbi

Authors: Gaurav Gupta MS Ortho. [1], Maulin M. Shah MBBS, M.S.Orth., DNB Orth. [1],
Akash S. Makadia MS Ortho. [2], Qaisur Rabbi D-Ortho. [2]

[1] Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, Gujarat, India.
[2] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi, India.
[3] Clinical Fellow (Paediatric Orthopaedics), OrthoKids Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Maulin M Shah,
Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, India
E-mail: maulinmshah@gmail.com

Abstract

Background: Treatment of Chronic Osteomyelitis in children results in varied outcome ranging from uneventful bone healing to gap non-union. We evaluated the factors associated with adverse outcome after a uniform treatment executed at a single centre.
Methods: 40 patients (1.5 -14 years) with Chronic Osteomyelitis managed with debridement & splintage were included in this study. Detailed history, laboratory investigations, local x rays & MRI were available for all the patients. Average follow up was of 2.5 years. Patients who ended up having healing of the bone after primary treatment were defined as ‘Good Outcome’, patients who required additional procedures to improve function of limb or morphology of bone were defined as ‘Fair Outcome’ and patients who resulted in gap non-union were defined as ‘Poor Outcome’.
Results: Delay in surgical intervention beyond 6 weeks after beginning of symptoms, multiple local debridement without pan-medullary decompression & presence of concomitant soft tissue abscess on MRI were the statistically significant factors associated with poor outcome.
Conclusion: Aggressive & early surgical debridement is suggested for patients with failed conservative treatment to avoid long term complications. Current study will help in identifying the patients who are likely to have long-term sequelae of Chronic Osteomyelitis.
Keywords: Chronic Osteomyelitis, pan-osseous, non-union, debridement, outcome.

Level of Evidence: IV, retrospective analytical study.

References 

1. Patwardhan S, Shyam A K, Reconstruction of Bone Defects After Osteomyelitis with Nonvascularized Fibular Graft. A Retrospective Study in Twenty-six Children. J Bone Joint Surg Am.2013; 95: e56 (1-6).
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How to Cite this Article: Gupta G, Shah MM, Makadia AS, Rabbi Q | Factors affecting the outcome of Chronic Osteomyelitis in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 16-21.

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Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware!

Volume 4 | Issue 1 | January-June 2018 | Page: 38-40 | Kiran Sasi, Binu P Thomas

DOI- 10.13107/ijpo.2018.v04i01.009

Authors: Kiran Sasi, Binu P Thomas

Department of Hand Surgery, Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Address of Correspondence
Dr. Binu P Thomas,
Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College and Hospital, Vellore – 632 004, Tamil Nadu, India.
E-mail: binu@cmcvellore.ac.in

Abstract

Distal femoral metaphyseal fracture is a common injury faced by paediatric orthopaedic surgeons. This injury is usually managed with closed reduction and percutaneous Kirschner wire fixation. We present an unusual case wherein the common peroneal nerve was completely severed and entrapped in the fracture site following closed reduction and percutaneous Kirschner wire fixation of a distal femoral metaphyseal fracture.
Keywords: Distal femur fracture, Foot drop, Nerve entrapment

References 

1. Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: A study using the general practice research database. J Bone Miner Res 2004;19:1976-81.
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How to Cite this Article:  Sasi K, Thomas BP | Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware! | January-June 2018; 4(1): 38- 40.

 

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