Stephanie A. Russo

Background: Children with brachial plexus birth injuries (BPBIs) may experience atypical posturing when performing activities of daily living, including eating. Clinical assessments often evaluate feeding ability through hand-to-mouth movements, using the unaffected arm as an internal control. This study examined differences between dominant and nondominant limbs and affected and unaffected BPBI limbs during feeding tasks and aimed to understand better the etiology of trumpeter posture in children with BPBI. Methods: Joint angles were measured during feeding tasks using 3-dimensional motion capture in 23 typically developing children aged 6 to 18 years. Previously collected hand-to-mouth motion data from children with BPBI were used. Analyses compared dominant versus nondominant limbs within the control group and differences between the BPBI group and the control group. Results: No differences were observed between dominant and nondominant limbs. In contrast, there were significant differences between the unaffected BPBI limb and the control group. The affected limb in the BPBI group differed from both the unaffected limb and the control group. The BPBI trumpeting group showed significantly decreased glenohumeral and humerothoracic external rotation and glenohumeral and humerothoracic cross-body adduction compared with the BPBI non-trumpeting group. Brachial plexus birth injury groups also showed significantly increased scapulothoracic internal rotation (scapular winging) compared with the BPBI unaffected and control groups. Conclusions: Symmetry was observed between dominant and nondominant limbs, but the unaffected BPBI limb differed from controls. Lack of external rotation was the primary factor in trumpeter posture, likely leading to compensatory movements affecting glenohumeral and humerothoracic joint motion. Glenohumeral and humerothoracic cross-body adduction may be secondary factors related to trumpeter posture.

Background: Brachial plexus birth injuries (BPBI) occur in up 0.4 to 4.6 per 1000 live births. Weakness about the shoulder and development of glenohumeral joint contractures are common sequalae of BPBI. Shoulder function in children with BPBI is frequently assessed using the modified Mallet classification to evaluate upper extremity motion deficits. The purpose of this study was to assess the accuracy of the abduction, external rotation, and hand-to-mouth Mallet classification scores in children with BPBI using motion capture. Methods: A retrospective study of 107 children with BPBI who underwent motion capture assessment and Mallet scores on the same date were reviewed. Motion capture measurements were used to calculate humerothoracic elevation and external rotation joint angles in the abduction/hand-to-mouth and external rotation positions, respectively. The humerothoracic joint angles were converted to the corresponding Mallet scores. Discrepancies between the Mallet scores determined by clinicians and those determined by motion capture were assessed. Results: For abduction, 24.3% of Mallet scores were misclassified during clinical examination. Of the misclassified scores, 22 were overestimated by 1 point and 4 were underestimated by 1 point compared with motion capture. For external rotation, 72.9% of Mallet scores were misclassified during clinical examination. Only 5 patients had an HT elevation that was less than 40 degrees, with 4 of them (80%) having a Mallet hand-to-mouth score of 4. There were no differences in proportion of patients with HT elevation less than 40 degrees who had a Mallet score of 4 or a Mallet score less than 4. Conclusions: There was better agreement in global abduction Mallet scores compared with external rotation and hand-to-mouth Mallet scores. This difference was likely due to the complex compensatory strategies that patients employ while performing external rotation and hand-to-mouth positions. The inaccuracy of the clinically determined Mallet scores is alarming given that they are frequently utilized to assist with surgical indications and are commonly used as outcome measures. Level of Evidence: Level IV Case series

Introduction: Our study aims to characterize the results of Monteggia fractures treated in our practice and to determine factors associated with good or poor outcomes. Methods: A retrospective review of children aged 17 and under with acute, subacute, or chronic Monteggia fractures who were treated at our institution was performed. The primary outcomes were initial reduction and maintenance of joint reduction, while the secondary outcomes were elbow flexion/extension and forearm supination/pronation. Results: Seventeen patients with Monteggia fractures were identified. Two patients were excluded: 1 was lost to follow-up and 1 had congenital absence of the elbow flexors. Thus, our final cohort was 15 patients (acute n = 3, subacute n = 4, chronic group n = 8). Median final follow-up was 1.9 years (range = 34 days-8 years). Conclusion: Preoperative range of motion (ROM) was the most important factor in determining postoperative ROM in this cohort of patients with chronic Monteggia fractures. All patients who presented with excellent preoperative ROM, regardless of their timing category, had an excellent ROM outcome. Time from initial injury also played an important role. All patients in the acute and subacute categories had good or excellent postoperative ROM. Patients who were further from the initial injury were more likely to present with worse preoperative ROM and, in turn, had worse outcomes with postoperative ROM.