The Transfer of the Latissimus Dorsi and Teres Major Muscles to the Teres Minor in the Correction of Abduction Deficit in Sequelae of Obstetric Brachial Plexus Palsy (About 75 Cases with Literature Review)

Objective: To study the contribution of the transfer of the latissimus dorsi and teres major muscles to the teres minor muscle in correcting the sequelae abduction deficit of OBPP and to evaluate the factors influencing the final outcome. Materials and Methods: A retrospective study was conducted on 75 patients followed in the Pediatric Trauma-Orthopedics B department at the Children’s Hospital of the Ibn Sina University Hospital Center in Rabat, over a period of 10 years. The Mallet score was adopted for the functional evaluation of the children. All patients were treated with the transfer of the Latissimus dorsi and Teres major muscles to the Teres minor to restore abduction, with postoperative immobilization in abduction-external rotation plaster for 4 weeks, followed by well-adapted rehabilitation with regular follow-up. Results: The average age at diagnosis was 22 months, and the average age at intervention was 4.20 years. 52% of the patients were female. In 71% of the cases, the affected side was the right, and the predominant form was the total form C5-T1. After the transfer, in terms of abduction, 64% of cases had excellent results (≥150°), 8% had good results (120°-150°), 21% had average results (90°-120°), and 7% had poor results (≤ 90°). Active external rotation improved by 47.67°, with an average of 50.94° (range: 10°-90°). Our average follow-up period was 6.68 years (ranging from 1 to 10 years), demonstrating the stability of the results. However, 2 patients experienced a recurrence of abduction limitation related to pectoralis major contracture and poorly followed rehabilitation.