Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391

Reza Sh. Kamrani M.D.Orthopaedic Hand Surgeon

TUMS, Shariati HospitalIsfehan UMS Annual Meeting

2-4 / 12 / 1391

Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.

Physical therapyPT/Release

TTOsteotomy

Osteotomy


Close observationPT

MicrosurgicalBP repair

NeurolysisNerve repairNerve graft

Nerve transfer


Conservative treatment

PT

OT

Butolonium Toxin

Surgical release ???

Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy

(Gleno-Humeral anatomy)

CT-MR

(Gleno-Humeral anatomy)CT-MR

Release

TT

Humeral Osteotomy

Release

TTHumeral Osteotomy+/_


Upper, Midd, Low

Ant, Med

Latismus Dorsi+/_

Teres maj

Shoulder

Elbow

Forearm

Hand


Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin




CT-MR


Release

TT

Humeral Osteotomy

Release



Upper, Midd, Low

Ant, Med

Latismus Dorsi+/_

Teres maj

Shoulder

Elbow

Forearm

Hand


Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin



CT-MR


Release

TT

Humeral Osteotomy



Upper, Midd, Low

Ant, Med

Latismus Dorsi+/_

Teres maj

Shoulder

Elbow

Forearm

Hand


Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin



CT-MR


Release

TT

Humeral Osteotomy


Upper, Midd, Low

Ant, Med

Latismus Dorsi+/_

Teres maj

Shoulder

Elbow

Forearm

Hand


Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin



CT-MR


Release

TT

Humeral Osteotomy


Upper, Midd, Low

Ant, Med

Latismus Dorsi+/_

Teres maj

Shoulder


Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin



CT-MR

Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y

Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin



CT-MR

Indication

Time of surgery

Kind of surgery

Alain Gilbert Howard Clarke

Biceps < 3/5 in 3m. Coockey sign in 9m.

spectrum



spectrum



spectrum

White zone

Poor biceps + Impaired hand in 3m. Poor biceps 6m.

Gray zone Poor biceps 3-6m

Neurolysis Nerve repair Nerve graft Nerve transfer

ADULT BP INJ. OBSTETRIC BP INJ.

Adult Infant Shorter regeneration

distance Stronger potential for

regeneration Greater capacity for

brain adaptation


Classic nerve transfer .Intra plexus

Avulsion is more common

.

Classic nerve transfer .Intra plexus

Avulsion is less common

.


Goal Goal


Goal Elbow flexion Shoulder stability

Goal Elbow flexion Shoulder reanimation


Goal Elbow flexion Shoulder stability Medial border

sensation Wrist and finger

function

Intrinsic function

Goal Hand function Elbow flexion Shoulder reanimation

Classic nerve graft is currently the most common approchroach for BPBP

But new nerve transfers is more and more popularised


New nerve transfers Becomes standard

approach

New nerve transfer Becomes more and

more popularised Acc. To Sup. Scap may

be the most common

Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y

Close observationPT



Nerve transfer



PT

OT

Butolonium Toxin



CT-MR

Indication

Time of surgery

Kind of surgery

23 months old boy BPBP Under observation from 5 months old

Shoulder Passive ROM is gradually reduced in spite of physical/occupational therapy

Shoulder plain X-ray is almost normal

What is the treatment?

Use Dysport

Dry vial = 500IU Dilution with normal saline Total dose 20-25 U/kg 1cc/location Price = 5,000,000R./1,200,000R.F Painful injection Nervelocator guided injectin

New bornSlingPT/OT

1-3 y

3-6 m Under-observation good Prog.

Passive should. ROM

Active elbow flexion

PT/OTAggress. PT/OT

3-6 m visit6 w visit

Br Plex microsurgery

goodbad

Soft tissue release

Passive Should. ROM Dysport injection

goodbad

6 w visitgoodbad

goodbad

Passive Should. ROM goodbad Humerus osteotomy?

Should. CT/MR

OR,Glenoid osteotomy,Arthroscopic release

3-6 m visit

3-6 m visit

Documents

Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391