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1.
J Shoulder Elbow Surg ; 28(9): 1764-1770, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31043347

RESUMO

BACKGROUND: Contracture of the elbow after obstetric brachial plexus palsy (OBPP) is well known; however, details of the 3-dimensional (3D) morphologic changes in the elbow joint in OBPP have not been clarified. This study aimed to clarify the 3D morphologic changes in the elbow joint by focusing on the distal humerus with flexion contracture in upper OBPP. We tested the hypothesis that the shape of the distal humerus with flexion contracture in upper OBPP is hypoplastic in the trochlea, capitellum, and olecranon fossa. METHODS: We retrospectively studied 20 patients with elbow flexion contracture and residual OBPP. The approximate radius of the distal humerus, the shortest distance between the olecranon and coronoid fossa, and the size of the olecranon fossa were measured and compared between the affected and normal sides using 3D bone models to assess the distal humerus morphology. RESULTS: The average radius of the distal humerus was smaller on the affected side than on the normal side. Furthermore, the average distance between the olecranon and coronoid fossa was greater and the average size of the olecranon fossa was smaller on the affected side than on the normal side. The size of the distal humerus was significantly smaller and the olecranon fossa was significantly shallower on the affected side. CONCLUSIONS: Consistent with our original hypothesis, the distal humerus with flexion contracture in upper OBPP was hypoplastic. The shallow olecranon fossa might prevent full extension of the elbow even though soft tissue contracture release is performed. We recommend evaluation of the morphology of the olecranon fossa to determine the treatment plan for elbow flexion contracture with OBPP.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/patologia , Contratura/patologia , Articulação do Cotovelo/patologia , Úmero/patologia , Adolescente , Neuropatias do Plexo Braquial/complicações , Criança , Pré-Escolar , Contratura/etiologia , Articulação do Cotovelo/diagnóstico por imagem , Epífises/diagnóstico por imagem , Epífises/patologia , Feminino , Humanos , Úmero/diagnóstico por imagem , Imagem Tridimensional , Luxações Articulares , Masculino , Estudos Retrospectivos
2.
Eur J Paediatr Neurol ; 23(4): 621-628, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078397

RESUMO

BACKGROUND: Early diagnosis of unilateral cerebral palsy is important after asymmetric perinatal brain injury (APBI). Our objective is to estimate the risk of unilateral cerebral palsy (UCP) in infants with APBI during the first months of life using neuroimaging and clinical assessment. PATIENTS AND METHODS: Prognostic multivariable prediction modeling study including 52 infants (27 males), median gestational age 39.3 weeks with APBI from Sweden (n = 33) and the Netherlands (n = 19). INCLUSION CRITERIA: (1) neonatal MRI within one month after term equivalent age (TEA), (2) Hand Assessment for Infants (HAI) between 3.5 and 4.5 months of (corrected) age. UCP was diagnosed ≥24 months of age. Firth regression with cross-validation was used to construct and internally validate the model to estimate the risk for UCP based on the predictors corticospinal tract (CST) and basal ganglia/thalamus (BGT) involvement, contralesional HAI Each hand sum score (EaHS), gestational age and sex. RESULTS: UCP was diagnosed in 18 infants (35%). Infants who developed UCP more often had involvement of the CST and BGT on neonatal MRI and had lower contralesional HAI EaHS compared to those who did not develop UCP. The final model showed excellent accuracy for UCP prediction between 3.5 and 4.5 months (area under the curve, AUC = 0.980; 95% CI 0.95-1.00). CONCLUSIONS: Combining neonatal MRI, the HAI, gestational age and sex accurately identify the prognostic risk of UCP at 3.5-4.5 months in infants with APBI.


Assuntos
Traumatismos do Nascimento/complicações , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/etiologia , Nomogramas , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Países Baixos , Neuroimagem/métodos , Gravidez , Suécia
3.
Plast Reconstr Surg ; 143(5): 1017e-1026e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033825

RESUMO

BACKGROUND: Infants with brachial plexus birth injury who do not recover motor function spontaneously in a timely manner are candidates for brachial plexus reconstruction with nerve autograft. Outcomes of this intervention are incompletely understood. The authors present the long-term outcomes of brachial plexus reconstruction with sural nerve autograft in infants with brachial plexus birth injury. METHODS: The authors retrospectively reviewed all infants with brachial plexus birth injury who underwent brachial plexus reconstruction with sural nerve autograft between 1992 and 2014 with a minimum 2-year follow-up. The authors used Active Movement Scale scores to determine the presence and timing of shoulder, elbow, and wrist recovery. They assessed recovery of hand function in infants with global brachial plexus birth injury with the Raimondi scale. The number and type of secondary reconstructive procedures were identified. RESULTS: Forty-three infants who underwent brachial plexus reconstruction at age 7 ± 2 months old were followed for 7 ± 5 years. Most infants recovered antigravity elbow flexion (91 percent) and shoulder abduction (67 percent), but fewer recovered antigravity shoulder external rotation (19 percent) and wrist extension (37 percent). Mean postoperative times until observed antigravity motor strength (Active Movement Scale score >5) at the shoulder, elbow, and wrist were all greater than 12 months; evidence of initial motor recovery (Active Movement Scale score >2) was observed earlier. The mean Raimondi score in infants with global brachial plexus birth injury was 2.2 (range, 0 to 5) at final follow-up. Thirty-three children underwent 2 ± 1.2 secondary reconstructive procedures. CONCLUSIONS: Brachial plexus reconstruction with sural nerve autograft reliably results in recovery of shoulder abduction and elbow flexion, but recovery of shoulder external rotation and wrist extension is less predictable, and recovery often takes more than 1 year. Secondary procedures are often performed to optimize function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Nervo Sural/transplante , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , Articulação do Cotovelo/inervação , Articulação do Cotovelo/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Articulação do Ombro/inervação , Articulação do Ombro/fisiologia , Transplante Autólogo/métodos , Resultado do Tratamento , Articulação do Punho/inervação , Articulação do Punho/fisiologia
4.
World Neurosurg ; 126: e1197-e1205, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885873

RESUMO

OBJECTIVE: Skull fractures caused by birth injury are mainly compression and linear fractures, but the incidence is known to be rare. It has been recently suggested, however, that greenstick fractures (GSFs) are more common than compression or linear fractures that are detected through 3-dimensional reconstructed computed tomography. Therefore, this study was conducted to determine the correlation of GSF with perinatal factors, the accompanying head injury factors, and the long-term outcomes in neonates. METHODS: A retrospective study was conducted on correlations between GSF and perinatal and head injury factors for 295 neonates. In 160 neonates, the correlation with long-term outcome was investigated. RESULTS: In 295 neonates, 47 cases had 3 or fewer GSFs, 66 cases had 4-6, 82 cases had 7-9, and 100 cases had 10 or more. The number of GSFs was significantly associated with gestational age and mode of delivery among the perinatal factors, with brain swelling and cephalohematoma among the head injury factors. It was also associated with long-term outcomes. The cut-off value of the number of GSFs for a poor outcome by the area under the receiver operating characteristic curve was 6 or greater. CONCLUSIONS: It was concluded that GSF most commonly occurs as a birth-related skull fracture and that birth-related GSF is associated with perinatal factors, birth-related head injuries, and deterioration of long-term development. Therefore, efforts should be made to prevent GSF at birth.


Assuntos
Traumatismos do Nascimento/complicações , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/etiologia , Fraturas Cranianas/etiologia , Desenvolvimento Infantil , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos
5.
Acta Orthop ; 90(2): 111-118, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30669911

RESUMO

Background and purpose - Patient selection for nerve surgery in brachial plexus birth injury (BPBI) is difficult. Decision to operate is mostly based on clinical findings. We assessed whether MRI improves patient selection. Patients and methods - 157 BPBI patients were enrolled for a prospective study during 2007-2015. BPBI was classified at birth as global plexus injury (GP) or upper plexus injury (UP). The global plexus injury was subdivided into flail upper extremity (FUE) and complete plexus involvement (CP). Patients were seen at set intervals. MRI was scheduled for patients that had either GP at 1 month of age or UP with no antigravity biceps function by 3 months of age. Type (total or partial avulsion, thinned root), number and location of root injuries and pseudomeningoceles (PMC) were registered. Position of humeral head (normal, subluxated, dislocated) and glenoid shape (normal, posteriorly rounded, pseudoglenoid) were recorded. Outcome was assessed at median 4.5 years (1.6-8.6) of age. Results - Cervical MRI was performed on 34/157 patients at median 3.9 months (0.3-14). Total root avulsions (n = 1-3) were detected on MRI in 12 patients (8 FUE, 4 CP). Reconstructive surgery was performed on 10/12 with total avulsions on MRI, and on all 10 with FUE at birth. Sensitivity and specificity of MRI in detecting total root avulsions was 0.88 and 1 respectively. Posterior shoulder subluxation/dislocation was seen in 15/34 patients (3.2-7.7 months of age). Interpretation - Root avulsion(s) on MRI and flail upper extremity at birth are both good indicators for nerve surgery in brachial plexus birth injury. Shoulder pathology develops very early in permanent BPBI.


Assuntos
Traumatismos do Nascimento , Plexo Braquial/lesões , Imagem por Ressonância Magnética/métodos , Pescoço/diagnóstico por imagem , Luxação do Ombro , Articulação do Ombro , Adulto , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/fisiopatologia , Plexo Braquial/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Seleção de Pacientes , Estudos Prospectivos , Amplitude de Movimento Articular , Sensibilidade e Especificidade , Luxação do Ombro/diagnóstico , Luxação do Ombro/etiologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia
6.
Eur J Paediatr Neurol ; 23(1): 87-93, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30458977

RESUMO

AIM: To assess the long-term outcome and evaluate prognostic factors in obstetric brachial plexus palsy (OBPP). METHODS: Of all 114 children with OBPP born in western Sweden in 1999-2001, 98 (61 males, 37 females) were invited to participate. A questionnaire on the symptoms of the OBPP was sent out and those with persisting symptoms were examined in terms of muscle strength, range of motion (ROM), activities of daily living (ADL), pain and sensibility at the age of 10-12 years. Contact was made by 87 children. RESULTS: The incidence of persisting OBPP at 10-12 years of age was calculated as 19 per 38,749 live births or 0.49 per 1000. Symptoms were reduced muscle strength and ROM in the arm. Eight children reported pain, four had impaired sensibility and ten children described some difficulties in ADL. Muscle strength in forearm supination, shoulder external rotation and elbow flexion at three months of age can be used to predict outcome. INTERPRETATION: Most children with an OBPP recover completely, but one in five has symptoms of the injury at 10-12 years of age. Muscle strength in the arm at three months of age can be used to predict outcome.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/congênito , Neuropatias do Plexo Braquial/complicações , Recuperação de Função Fisiológica , Atividades Cotidianas , Traumatismos do Nascimento/epidemiologia , Neuropatias do Plexo Braquial/epidemiologia , Criança , Feminino , Humanos , Incidência , Masculino , Força Muscular/fisiologia , Dor/epidemiologia , Dor/etiologia , Gravidez , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/etiologia , Suécia
8.
J Pediatr Orthop ; 39(1): 14-21, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28834853

RESUMO

BACKGROUND: Upper extremity function in children with brachial plexus birth palsy (BPBP) is assessed with clinical tests such as the Mallet classification, which uses a hand to spine position to assess shoulder internal rotation, or the modified Mallet classification, which adds an additional internal rotation task (hand to belly). Children with BPBP frequently have difficulty performing the hand to spine task. This study compared scapulothoracic and glenohumeral (GH) parameters associated with successful completion of the hand to spine and hand to belly modified Mallet positions. METHODS: Motion capture measurement of 32 children with BPBP was performed in hand on spine, internal rotation (hand to belly), hand to mouth, and maximal humerothoracic extension positions. Modified Mallet scores were determined by a hand surgeon. RESULTS: Children with better hand to spine performance demonstrated significantly greater GH extension and a nonsignificant trend toward increased GH internal rotation compared with children with scores <3. Children with better internal rotation position performance demonstrated significantly greater GH internal rotation and no significant difference in GH extension. Hand on spine and internal rotation Mallet scores moderately correlated (Pearson r=0.469); however, 54% of children who could place their palms flat on their bellies could not reach behind their backs. CONCLUSIONS: Successfully reaching behind one's back requires both internal rotation and extension, representing a multiplanar motion. The hand to belly performance is less affected by extension and should be considered for internal rotation assessment, particularly for children undergoing surgical intervention that may affect internal rotation. LEVEL OF EVIDENCE: Level II.


Assuntos
Neuropatias do Plexo Braquial/fisiopatologia , Movimento , Rotação , Articulação do Ombro/fisiopatologia , Extremidade Superior/fisiopatologia , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/etiologia , Criança , Pré-Escolar , Mãos , Humanos , Amplitude de Movimento Articular , Índice de Gravidade de Doença
9.
J Pediatr Orthop ; 39(2): e134-e140, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29016426

RESUMO

BACKGROUND: The epidemiology of brachial plexus birth palsy (BPBP) in the United States may be changing over time due to population-level changes in obstetric care. METHODS: The Kids' Inpatient Database from 1997 to 2012 was analyzed. Annual estimates of BPBP incidence and disease determinant distribution were calculated for the general population and the study population with BPBP. Long-term trends were analyzed. A multivariate logistic regression model was used to quantify the risk associated with each determinant. RESULTS: The database yielded a combined total of 5,564,628 sample births extrapolated to 23,385,597 population births. The population incidence of BPBP dropped 47.1% over the 16-year study period, from 1.7 to 0.9 cases per 1000 live births (P<0.001). Female, black, and Hispanic subgroups had moderately increased risks of BPBP. Among children with BPBP, 55.0% had no identifiable risk factor. Shoulder dystocia was the strongest risk factor for BPBP in the regression model [odds ratio (OR), 113.2; P<0.001], although the risk of sustaining a BPBP in the setting of shoulder dystocia decreased from 10.7% in 1997 to 8.3% in 2012 (P=0.006). Birth hypoxia was independently associated with BPBP (OR, 3.1; P<0.001). Cesarean delivery (OR, 0.16; P<0.001) and multiple gestation birth (OR, 0.45; P<0.001) were associated with lower incidence of BPBP. Notably, the rate of cesarean delivery increased by 62.8% during the study period, from 20.9% in 1997 to 34.0% in 2012 (P<0.001). CONCLUSIONS: Over a 16-year period, the incidence of BPBP fell dramatically, paralleled by a significant increase in the rate of cesarean delivery. Systemic changes in obstetric practice may have contributed to these trends. As more than half of BPBP cases have no identifiable risk factor, prospective investigation of established risk factors and characterization of new disease determinants are needed to more reliably identify infants at greatest risk. Racial and geographic inequalities in disease burden should be investigated to identify interventional targets. LEVEL OF EVIDENCE: Level III-case series.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/epidemiologia , Plexo Braquial/lesões , Cesárea , Criança , Distocia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
10.
J Shoulder Elbow Surg ; 27(10): 1779-1784, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29859662

RESUMO

BACKGROUND: Glenohumeral (GH) contractures appear in most patients with incomplete motor recovery as a result of progressive development of periarticular muscle contractures. The objectives of this study were to describe a method to measure the passive range of motion of the glenohumeral joint (GHJ) in patients with brachial plexus birth palsy (BPBP) and to evaluate its intraobserver and interobserver reproducibility. METHODS: Three orthopedic surgeons measured the passive GHJ mobility of 25 patients older than 4 years with unilateral BPBP. Measurements were performed twice on both shoulders. They comprised the spinohumeral abduction angle (SHABD), spinohumeral adduction angle (SHADD), GH cross-body adduction (CBADD), and GH internal rotation in abduction (IRABD). Anterior GH contracture was not evaluated. RESULTS: Passive shoulder measurements obtained from the uninvolved and involved shoulders were as follows: SHABD, 42° and 18°, respectively; SHADD, 14° and -1°, respectively; CBADD, 71° and 41°, respectively; and IRABD, 54° and 37°, respectively. Contracture of the lower portion of the involved GHJ was observed in 18 of 25 patients (72%); the upper portion, in 16 of 25 (64%); and the posterior portion, in 22 of 25 (88%). Interobserver variation (intraclass correlation coefficient) was 0.91 (excellent) for SHABD, 0.63 (good) for SHADD, 0.86 (excellent) for CBADD, and 0.67 (good) for IRABD. Intraobserver variation (intraclass correlation coefficient) was 0.94 (excellent) for SHABD, 0.87 (excellent) for SHADD, 0.92 (excellent) for CBADD, and 0.89 (excellent) for IRABD. CONCLUSIONS: Clinical measurements of passive GHJ range-of-motion analyzed in this study showed excellent or good intraobserver and interobserver variability. Our study showed that BPBP resulted in a multidirectional GH contracture in most patients. We have described a simple and reliable way to evaluate passive GH motion, providing reliable anatomic landmarks.


Assuntos
Neuropatias do Plexo Braquial/fisiopatologia , Contratura/fisiopatologia , Amplitude de Movimento Articular , Articulação do Ombro/fisiopatologia , Adolescente , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/etiologia , Criança , Pré-Escolar , Contratura/etiologia , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Exame Físico/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Rotação
11.
J Hand Surg Am ; 43(9): 871.e1-871.e7, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29605518

RESUMO

PURPOSE: Shoulder arthroplasty following obstetrical brachial plexus injury (OBPI) is technically challenging because glenoid morphology, muscle balance, and humeral version are substantially altered compared with the neurologically intact shoulder. The purpose of this study is to report the outcome of shoulder arthroplasty in a group of patients with end-stage arthritis secondary to OBPI. MATERIALS AND METHODS: Seven patients with OBPI and secondary glenohumeral arthritis were treated with shoulder arthroplasty between 1976 and 2014. Two underwent hemiarthroplasty (HA), 2 underwent total shoulder arthroplasty (TSA), and 3 underwent reverse shoulder arthroplasty (RSA). One HA was lost to follow-up and was excluded. The remaining 6 patients (mean age, 62.5 years old at the time of surgery) were followed for a minimum of 2 years (mean, 7.5 years; range, 2-13 years) Outcome measures included pain, range of motion, and postoperative modified Neer ratings. RESULTS: Pain improved in all shoulders. Mean forward flexion was unchanged. No shoulders treated with HA/TSA regained forward elevation above 90°, compared with 1 out of the 3 RSAs. External rotation improved from a mean of -10° to 20°. Active internal rotation decreased from L1 to L5. Immediate postoperative radiographs showed either severe posterior or posterosuperior subluxation in all 3 patients treated with nonconstrained implants. CONCLUSIONS: Shoulder arthroplasty is an acceptable option to relieve pain in patients with symptomatic shoulder arthritis as a sequel of OBPI. However, range of motion improvements are not expected. TYPE OF STUDY /LEVEL OF EVIDENCE: Therapeutic V.


Assuntos
Artrite/cirurgia , Artroplastia do Ombro , Neuropatias do Plexo Braquial/complicações , Plexo Braquial/lesões , Hemiartroplastia , Articulação do Ombro/cirurgia , Idoso , Artrite/etiologia , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Sistema de Registros , Rotação , Dor de Ombro/cirurgia , Escala Visual Analógica
12.
J Neonatal Perinatal Med ; 11(1): 61-64, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689744

RESUMO

BACKGROUND: The incidence of clavicle fracture in the newborn population ranges from 0.2 to 3.5% with an associated rate of obstetric brachial palsy (OBP) ranging from 4 to 13% . METHODS: The aim of this study was to describe the anatomical location of the fracture in the clavicle and its possible correlation with OBP. We retrospectively reviewed all perinatal clavicle fractures diagnosed at our institution over thirteen years. RESULTS: A total of 155 clavicle fractures were identified among 23508 live newborns representing an incidence of 0.67% . Fracture location was categorized according to the Allman classification. The most frequent location was the mid-shaft (Allman I) (92.90%), followed by the medial third (Allman III) (5.81%) and finally by the lateral third (Allman II) (1.29%). 17 cases had an associated OBP (10.97%). 13 of these cases (76.47%) involved the medial third, 4 involved the midshaft (23.53%) whilst none of the cases with a clavicle fracture involving the lateral third was associated to OBP. We could determine a significant association between the occurrence of OBP and fracture of the clavicle medial third (Allman type III) (p < 0.05). CONCLUSIONS: To the best of our knowledge this is the first study describing the anatomical location of the fracture in the clavicle and its possible association with OBP. A fracture involving the medial clavicle third in a newborn might alert of the possible event of OBP. Nevertheless, more studies with larger samples will be necessary to confirm these results.


Assuntos
Traumatismos do Nascimento/epidemiologia , Neuropatias do Plexo Braquial/epidemiologia , Clavícula/lesões , Fraturas Ósseas/epidemiologia , Índice de Apgar , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/etiologia , Diáfises/lesões , Distocia/epidemiologia , Feminino , Fraturas Ósseas/complicações , Humanos , Incidência , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco
13.
Epilepsia ; 59(5): 905-914, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29637551

RESUMO

Among the causes of epilepsy are several that are currently preventable. In this review, we summarize the public health burden of epilepsy arising from such causes and suggest priorities for primary epilepsy prevention. We conducted a systematic review of published epidemiologic studies of epilepsy of 4 preventable etiologic categories-perinatal insults, traumatic brain injury (TBI), central nervous system (CNS) infection, and stroke. Applying consistent criteria, we assessed the quality of each study and extracted data on measures of risk from those with adequate quality ratings, summarizing findings across studies as medians and interquartile ranges. Among higher-quality population-based studies, the median prevalence of active epilepsy across all ages was 11.1 per 1000 population in lower- and middle-income countries (LMIC) and 7.0 per 1000 in high-income countries (HIC). Perinatal brain insults were the largest attributable fraction of preventable etiologies in children, with median estimated fractions of 17% in LMIC and 15% in HIC. Stroke was the most common preventable etiology among older adults with epilepsy, both in LMIC and in HIC, accounting for half or more of all new onset cases. TBI was the attributed cause in nearly 5% of epilepsy cases in HIC and LMIC. CNS infections were a more common attributed cause in LMIC, accounting for about 5% of all epilepsy cases. Among some rural LMIC communities, the median proportion of epilepsy cases attributable to endemic neurocysticercosis was 34%. A large proportion of the overall public health burden of epilepsy is attributable to preventable causes. The attributable fraction for perinatal causes, infections, TBI, and stroke in sum reaches nearly 25% in both LMIC and HIC. Public health interventions addressing maternal and child health care, immunizations, public sanitation, brain injury prevention, and stroke prevention have the potential to significantly reduce the burden of epilepsy.


Assuntos
Epilepsia/prevenção & controle , Prevenção Primária/métodos , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/prevenção & controle , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/prevenção & controle , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/prevenção & controle , Epilepsia/etiologia , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/prevenção & controle
14.
J Hand Surg Am ; 43(5): 417-424, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29395588

RESUMO

PURPOSE: Brachial plexus birth injuries with multiple nerve root avulsions present a particularly difficult reconstructive challenge because of the limited availability of donor nerves. The contralateral C7 has been described for brachial plexus reconstruction in adults but has not been well-studied in the pediatric population. We present our technique and results for retropharyngeal contralateral C7 nerve transfer to the lower trunk for brachial plexus birth injury. METHODS: We performed a retrospective review. Any child aged less than 2 years was included. Charts were analyzed for patient demographic data, operative variables, functional outcomes, complications, and length of follow-up. RESULTS: We had a total of 5 patients. Average nerve graft length was 3 cm. All patients had return of hand sensation to the ulnar nerve distribution as evidenced by a pinch test, unprompted use of the recipient limb without mirror movement, and an Active Movement Scale (AMS) of at least 2/7 for finger and thumb flexion; one patient had an AMS of 7/7 for finger and thumb flexion. Only one patient had return of ulnar intrinsic hand function with an AMS of 3/7. Two patients had temporary triceps weakness in the donor limb and one had clinically insignificant temporary phrenic nerve paresis. No complications were related to the retropharyngeal nerve dissection in any patient. Average follow-up was 3.3 years. CONCLUSIONS: The retropharyngeal contralateral C7 nerve transfer is a safe way to supply extra axons to the severely injured arm in brachial plexus birth injuries with no permanent donor limb deficits. Early functional recovery in these patients, with regard to hand function and sensation, is promising. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/cirurgia , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Nervo Ulnar/cirurgia
15.
Tech Hand Up Extrem Surg ; 22(1): 10-14, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29369125

RESUMO

Forearm supination contractures can occur as a result of neurological derangement of the upper extremity. Primarily, this is observed in patients with neonatal brachial plexus birth palsy. The contractures develop slowly over time and become problematic in childhood as the patients begin requiring forearm pronation for activities of daily living including typing on a keyboard and writing. Although supination contracture is a well-described sequelae of neonatal brachial plexus birth palsy, there is a paucity of literature describing techniques and outcomes for reconstruction and restoration of forearm pronation. The initially described technique included release of the interosseous membrane for flexibility combined with rerouting of part of the biceps tendon to change its biomechanical pull from supination to pronation. More recently, bone and soft tissue procedures have been combined with various forearm osteotomies. We present a combined derotational radial osteotomy and biceps rerouting to realign the forearm in resting pronation and convert the biceps from a supinator to a pronator. This novel surgical technique has not been described as a solution for supination contracture to restore pronation and provide biomechanical advantage of the biceps insertion.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Contratura/cirurgia , Osteotomia/métodos , Rádio (Anatomia)/cirurgia , Transferência Tendinosa/métodos , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/etiologia , Moldes Cirúrgicos , Criança , Pré-Escolar , Contratura/fisiopatologia , Antebraço/fisiopatologia , Antebraço/cirurgia , Humanos , Procedimentos Ortopédicos/métodos , Cuidados Pós-Operatórios , Pronação/fisiologia , Contenções , Supinação/fisiologia
16.
J Orthop Res ; 36(7): 1991-1997, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29244216

RESUMO

Neonatal brachial plexus injury (NBPI) results in substantial postural and functional impairments associated with underlying muscular and osseous deformities. We examined the relationship between glenoid deformity severity and gait in a rat model of NBPI, an established model for studying the in vivo pathomechanics of NBPI. At 8 weeks post-operatively, we monitored the gait of 24 rat pups who exhibited varying degrees of glenoid deformity following unilateral brachial plexus neurectomy and chemodenervation interventions administered 5 days postnatal. Five basic stride and stance metrics were calculated for the impaired forelimbs over four consecutive gait cycles. Bilateral differences in glenoid version (ΔGAv ) and inclination (ΔGAi ) angles were computed from data for the same rats as reported in a previous study. A linear regression model was generated for each deformity-gait pair to identify significant relationships between the two. ΔGAv was not significantly correlated with any gait measurements, while ΔGAi significantly correlated with all five gait measurements. Specifically, ΔGAi was significantly positively correlated with stride length (R2 = 0.38, p = 0.001) and stance factor (R2 = 0.45, p < 0.001), and significantly negatively correlated with stance width (R2 = 0.24, p = 0.016), swing/stance ratio (R2 = 0.17, p = 0.046), and stride frequency (R2 = 0.33, p = 0.003). Rats with declined glenoids exhibited the most altered gait. CLINICAL SIGNIFICANCE: Our findings link musculoskeletal changes and functional outcomes in an NBPI rat model. Thus, gait analysis is a potentially useful, non-invasive, quantitative way to investigate the effects of injury and deformity on limb function in the NBPI rat model. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1991-1997, 2018.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/complicações , Marcha , Animais , Animais Recém-Nascidos , Traumatismos do Nascimento/fisiopatologia , Plexo Braquial , Neuropatias do Plexo Braquial/fisiopatologia , Contratura/fisiopatologia , Músculo Esquelético/patologia , Amplitude de Movimento Articular , Ratos , Ratos Sprague-Dawley , Análise de Regressão , Estudos Retrospectivos , Escápula/fisiopatologia , Articulação do Ombro/fisiopatologia , Microtomografia por Raio-X
18.
Br J Neurosurg ; 32(6): 691-693, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28264585

RESUMO

Intradiploic hematoma is extremely rare, especially in infant patients. Less than 15 cases were reported in English literature up to now. Here, we presented another intradiploic hematoma in an infant boy without coagulopathy. A left parietal craniotomy was performed. Post-operative CT showed well-reconstructed skull.


Assuntos
Doenças Ósseas/cirurgia , Hematoma/cirurgia , Osso Parietal/cirurgia , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/patologia , Doenças Ósseas/etiologia , Doenças Ósseas/patologia , Calcinose/etiologia , Calcinose/patologia , Calcinose/cirurgia , Craniotomia/métodos , Hematoma/etiologia , Hematoma/patologia , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Osso Parietal/patologia , Tomografia Computadorizada por Raios X
19.
J Pediatr Orthop ; 38(1): 32-37, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26886458

RESUMO

BACKGROUND: Few studies have investigated outcomes after adjunct botulinum toxin type A (BTX-A) injections into the shoulder internal rotator muscles during shoulder closed reduction and spica cast immobilization in children with brachial plexus birth palsy. The purpose of this study was to report success rates after treatment and identify pretreatment predictors of success. METHODS: Children with brachial plexus birth palsy who underwent closed glenohumeral joint reduction with BTX-A and casting were included. Minimum follow-up was 1 year. Included patients did not receive concomitant shoulder surgery nor undergo microsurgery within 8 months. Records were reviewed for severity of palsy, age, physical examination scores, passive external rotation (PER), and subsequent orthopaedic procedures (repeat injections, repeat reduction, shoulder tendon transfers, and humeral osteotomy). Treatment success was defined in 3 separate ways: no subsequent surgical reduction, no subsequent closed or surgical reduction, and no subsequent procedure plus adequate external rotation. RESULTS: Forty-nine patients were included. Average age at time of treatment was 11.5 months. Average follow-up was 21.1 months (range, 1 to 9 y). Thirty-two patients (65%) required repeat reduction (closed or surgical). Only 16% of all patients obtained adequate active external rotation without any subsequent procedure. Increased PER (average 41±14 degrees, odds ratio=1.21, P=0.01) and Active Movement Scale external rotation (average 1.3, odds ratio=2.36, P=0.02) predicted optimal treatment success. Limited pretreatment PER (average -1±17 degrees) was associated with treatment failure. Using the optimal definition for success, all patients with pretreatment PER>30 degrees qualified as successes and all patients with PER<15 degrees were treatment failures. CONCLUSIONS: Pretreatment PER>30 degrees can help identify which patients are most likely to experience successful outcomes after shoulder closed reduction with BTX-A and cast immobilization. However, a large proportion of these patients will still have mild shoulder subluxation or external rotation deficits warranting subsequent intervention. LEVEL OF EVIDENCE: Level IV-therapeutic.


Assuntos
Traumatismos do Nascimento/complicações , Toxinas Botulínicas Tipo A/uso terapêutico , Neuropatias do Plexo Braquial/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Amplitude de Movimento Articular/efeitos dos fármacos , Articulação do Ombro/efeitos dos fármacos , Neuropatias do Plexo Braquial/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Injeções Intramusculares , Masculino , Resultado do Tratamento
20.
J Hand Ther ; 31(3): 357-370, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28454773

RESUMO

STUDY DESIGN: Cross-sectional clinical measurement study. INTRODUCTION: Scapular winging is a frequent complaint among children with brachial plexus birth palsy (BPBP). Therapeutic taping for scapular stabilization has been reported to decrease scapular winging. PURPOSE OF THE STUDY: This study aimed to determine which therapeutic taping construct was most effective for children with BPBP. METHODS: Twenty-eight children with BPBP participated in motion capture assessment with 4 taping conditions: (1) no tape, (2) facilitation of rhomboid major and rhomboid minor, (3) facilitation of middle and lower trapezius, and (4) facilitation of rhomboid major, rhomboid minor, and middle and lower trapezius (combination of both 2 and 3, referred to as combined taping). The participants held their arms in 4 positions: (1) neutral with arms by their sides, (2) hand to mouth, (3) hand to belly, and (4) maximum crossbody adduction (CBA). The scapulothoracic, glenohumeral and humerothoracic (HT) joint angles and joint angular displacements were compared using multivariate analyses of variance with Bonferroni corrections. RESULTS: Scapular winging was significantly decreased in both the trapezius and combined taping conditions in all positions compared with no tape. Rhomboids taping had no effect. Combined taping reduced HT CBA in the CBA position. CONCLUSIONS: Rhomboid taping cannot be recommended for treatment of children with BPBP. Both trapezius and combined taping approaches reduced scapular winging, but HT CBA was limited with combined taping. Therefore, therapeutic taping of middle and lower trapezius was the most effective configuration for scapular stabilization in children with BPBP. Resting posture improved, but performance of the positions was not significantly improved. LEVEL OF EVIDENCE: Level II.


Assuntos
Fita Atlética , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/terapia , Neuropatias do Plexo Braquial/reabilitação , Plexo Braquial/lesões , Articulação do Ombro/fisiopatologia , Adolescente , Neuropatias do Plexo Braquial/fisiopatologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Amplitude de Movimento Articular
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