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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 2, 213-219.
doi: 10.1302/0301-620X.88B2.17185  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Posterior subluxation and dislocation of the shoulder in obstetric brachial plexus palsy

S. B. S. Kambhampati, FRCS, Registrar in Orthopaedics1; R. Birch, MChir, FRCS, Professor2; C. Cobiella, FRCS, Consultant Orthopaedic Surgeon3; and L. Chen, MD, Professor4

1 Hillingdon Hospital, 9 Rushden Gardens, Mill Hill, London NW7 2PA, UK.
2 Peripheral Nerve Injury Unit Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
3 Whittington Hospital NHS Trust, Highgate Hill, London N15 5NF, UK.
4 Department of Orthopaedics Hua Shan Hospital, Shanghai, People’s Republic of China.

Correspondence should be sent to Professor R. Birch; e-mail: benita.patel{at}rnoh.nhs.uk

We describe the results of surgical treatment in a prospective study of 183 consecutive cases of subluxation (101) and dislocation (82) of the shoulder secondary to obstetric brachial plexus palsy between 1995 and 2000. Neurological recovery was rated ‘good’ or ‘useful’ in all children, whose lesions fell into groups 1, 2 or 3 of the Narakas classification. The mean age at operation was 47 months (3 to 204). The mean follow-up was 40 months (24 to 124).

The mean gain in function was 3.6 levels (9.4 to 13) using the Mallet score and 2 (2.1 to 4.1) on the Gilbert score. The mean active global range of shoulder movement was increased by 73°; the mean range of active lateral rotation by 58° and that of supination of the forearm by 51°. Active medial rotation was decreased by a mean of 10°. There were 20 failures. The functional outcome is related to the severity of the neurological lesion, the duration of the dislocation and onset of deformity.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General