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J Hand Microsurg 2023; 15(03): 203-211
DOI: 10.1055/s-0041-1739962
Original Article

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Ahmed Fathy Sadek
1   Hand and Microsurgery Unit, Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
,
Mohamed A. Ellabban
2   Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
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Abstract

Introduction Elbow flexion is indispensable for both functioning and nonfunctioning hands. It is well perceived that restoration of elbow function is the first reconstructive priority in cases of brachial plexus injuries. The authors assessed the impact of associated distal humeral fractures on the functional outcome after unipolar latissimus dorsi transfer (ULDT) for restoration of elbow flexion in patients with residual brachial plexus palsy (BPP).

Patients and Methods Twenty-three patients operated for restoring elbow flexion after residual post-traumatic BPP (with or without distal humeral fracture) by unipolar latissimus dorsi transfer (ULDT) were reviewed for a retrospective study. Patients were divided into two groups; associated distal humeral fracture group (HF-group; 10 patients) and non-associated distal humeral fracture group (NHF-group; 13 patients). Elbow flexion active range of motion (AROM), flexion deformity in addition to Mayo Elbow Performance Score (MEPS) were assessed.

Results In both groups there were statistically better postoperative MEPS grading (p = 0.007, p = 0.001, respectively) and scoring with a mean of 81 ± 16.1 and 90 ± 4.6, respectively (p < 0.001). The mean postoperative elbow flexion AROM was statistically better in both groups. The mean supination AROM was better in NHF group (p = 0.057).

Conclusion The use of ULDT in residual post-traumatic BPP is an efficient procedure in regaining functional flexion and supination. An associated distal humeral fracture does not significantly affect the final functional outcome.

Level of Evidence Level IV.

Keywords

latissimus dorsi - restoration of elbow flexion - residual brachial plexus palsy - distal humeral fracture

Authors' Contribution

A.F.S. and M.A.E. actively and evenly participated in the following: performing the surgical procedures, clinical and radiological evaluations of the patients and preparing the manuscript. A.F.S. has made the final manuscript edition.


Ethical Committee Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. A retrospective comparative two center study was conducted after obtaining the approval of the human ethical committees of the two institutions involved (No: 140–12/2018).


Informed Consent

A full informed written consent has been obtained from all patients reviewed for this study including full awareness and knowledge of the nature of the study, the possible submission to interviews, clinical evaluation, or any other assessment tool.




Publication History

Article published online:
01 December 2021

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