One Step Shoulder Soft Tissues Reconstruction and Surgery Treatment of Triangle Tilt of Glenoid Due to Sequlae of Brachial Plexus Birth Palsy

Objective: Brachial Plexus Birth palsy usually result in Shoulder deformities lead to poor function, loss of quality of life and pain.The purpose of our study is to examine the results of combined in one step shoulder soft tissues reconstruction and triangle tilt procedure on improvement of shoulder function and development.Method: A major treatment goal in children with obstetric brachial plexus palsy (OBPP) is to obtain optimal range of shoulder motion through improved glenohumeral alignment.In our study (34 cases of shoulder sequelae in brachial plexus birth palsy) medial rotation contracture with shoulder subluxation or dislocation and SHEAR deformity, mean age (5.4 year), mean follow up (31.2 months).We combine in one step anterior shoulder release (subscapularis release , coracohumeral and coracoacromial ligament release , pectoralis major lengthening , latissimusdorsi and teres major transfer to teres minor and the triangle tilt procedure , establishing glenohumeral congruency is the target , repositioning of the glenohumeral joint to maximize alignment does not only improve function and growth, but has been provided encourage joint remodeling Results: 34 cases of ( OBPP ) with medial rotation contracture with shoulder subluxation or dislocation and SHEAR deformity , mean age ( 5.4 year ) , mean follow up ( 31.2 months ) combined in one step shoulder soft tissues reconstruction and triangle tilt resulted in significant increase in overall modified Mallet score ( 11.2 ) to ( 19.7 ) , p value ( < 0.0001 ) and significant increase in mean glenoid version ( 17.2 ) to ( -4 ) , p value ( < 0.0001 ) , mean percentage of humeral head anterior ( 8 ) to ( 47.8 ) , p value ( < 0.0001 ) and mean scapular elevation ( 20.7 ) to ( 7. 4 ) , p value ( < 0.0001 ) , difference in abduction and scapular elevation were significantly correlated with age , for the difference in abduction ( r = -0.4, p = 0.0029 ) and for the difference in scapular elevation ( r = -0.4, p = 0.0045 ) .Conclusion: statistically significant improvement in shoulder function and radiological outcomes after our study (combined in one step shoulder soft tissues reconstruction and Triangle tilt) is good method for patients who have developed a medial rotation contracture with shoulder subluxation or dislocation and SHEAR deformity.Anterior shoulder release addresses the contracted Anterior structure of shoulder joint so relocate the humeral head in anterior glenoid fossa, the triangle tilt procedure addresses medial rotation and glenohumeral deformity, so in our study we can manage late sequlae of shoulder in OBBP.