الفهرس 
Historical backgroundOnly 14 pages are availabe for public view
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Abstract
Obstetric brachial plexus paralysis (OBPP) results from traction injury during difficult labour that has recently declined due to good obstetric care. The anatomical location of brachial plexus makes it liable to injury. Most patients recover spontaneously, incomplete recovery leads to residual deformity which may affect the shoulder, elbow, wrist or hand. The commonest of them is the shoulder deformity in the form of internal rotation contracture and limited global abduction.
Many operations have been described for correction of shoulder deformities in Erb′s palsy. These include soft tissue release, tendon transfer and osseous procedures. The main goal of treatment is to regain external rotation and abduction to minimize secondary bony changes and maintain function of shoulder.
The aim of the study was to compare between deltopectoral and transaxillary approaches for combined latissmus dorsi and teres major muscle transfer to infraspinatus after anterior release of pectoralis major , subscaularis muscle and shoulder joint capsule if needed. Postoperatively the shoulder spicca is removed 6-8 weeks later, physiotherapy is begun and follow up of the patients at 2,4,6 months .
The modified Mallet and Gilbert scores was used for assessment of the shoulder global abduction and external rotation pre and postoperatively. A PXR and EMG study of the muscles around the shoulder were done to all patients.
This study included 30 patients with Erb′s palsy with decreased global abduction and external rotation. Fifteen patients operated using each approach. In deltopectoral approach, There were 9 patients ≤4years and 6 patients >4years with the mean value 3.87 ± 1.41 years while in transaxillary group ,there were 7 patients ≤4years and 8 patients >4years with the mean value 4.33 ± 1.45 years. Patients(73.6%). By using the deltopectoral approach , there was improvement in active global abduction from a mean of 80.33 ± 17.16(range, 50.0 – 110.0) degree preoperatively to a mean of 106.67 ± 18.77(range, 90.0 – 160.0) degree post operatively and also there was improvement of active external rotation from a mean of 9.0 ± 7.37 (range, 0.0 – 20.0) degrees preoperatively to a mean of 27.0 ± 6.76(range, 20.0 – 40.0) degrees post operatively. But by using the transaxillary approach, there was improvement in external rotation from a mean of 5.67 ± 6.78(range, 0.0 – 20.0)degrees preoperatively to a mean of 28.0 ± 7.27 (range, 20.0 – 40.0) degrees post operatively, also there was improvement in active abduction from a mean of 81.33 ± 20.57 (range, 45.0 – 110.0) degree preoperatively to a mean of 118.0 ± 18.97(range, 90.0 – 150.0)degree post operatively.
According to the modified Mallet and Gilbert scores, there was no statically difference between deltopectoral and transaxillary approaches as for improvement in abduction and external rotation but there was a statistically significant difference between pre and postoperative improvement of shoulder movements in each surgical approach alone. Transaxillary approach has less operative time,less blood loss and better postoperative scar .
Postoperative complication were little . Loss of the last degrees of internal rotation occurred in 3 patients (20%) of deltopectoral approach and in 2 of transaxillary approach (15%). Postoperative mild infection occurred in only 2 patients of each approach.