ROLE OF SAHA'S PROCEDURE IN CHANGE OF MOVEMENT AT SHOULDER JOINT IN TRAUMATIC BRACHIAL PLEXUS INJURIES 1 1 1 1 Shujaat Hussain, Aftab Hussain, Muhammad Javed, Tahseen Ahmed Cheema ABSTRACT Background: Brachial plexus injuries are difficult to manage situation for surgeons. Objective: To assess the effects of saha's procedure on improving the range of movement of shoulder joint with brachial plexus injury. Methodology: We conducted a quasi-experimental study of twelve patients with absent or extremely weak shoulder abduction (motor grade 2 or less) due to traumatic brachial plexus injuries (C5-C6-C7/C5-C6 deficit), who had undergone surgical reconstruction of the flail shoulder by tendon transfer (Steindler elbow flexorplasty). The etiology of shoulder weakness in all patients was traumatic brachial plexus st st palsy (C5-C6-C7/C5-C6 deficit) from 1 January 2011 to 31 December 2014. Shoulder abduction improved or not improved measured in term of range of motion at shoulder joint. Age, gender, preoperative strength (rated on a 0 to 5 scale for the trapezius), previous surgery, length of follow-up, other associated operative procedures, results and complications were recorded. Results: We operated on twelve patients and average age at which patients presented was 22.83 in which only one was female. The percentage years of C5-C6 and C5-C6-C7 were 86.66% and 13.33% respectively. Average time elapsed since injury was 23 0 months. We followed the patients on average of about 2 years. The Average increase (change) in the abduction range was 74.1 Conclusion: Saha's procedure is good and effective procedure in improving the range of motion (Change) at shoulder joint in traumatic brachial plexus injuries (C5-C6-C7/C5-C6 deficit). Key word: Saha's procedure, Shoulders, Abduction, Brachial plexus, Injury. INTRODUCTION Abduction is the most important functional movement of the glenohumeral joint, and at the same time one of the most complex movements of 1 the entire body. Traction injury of the brachial plexus results in paralysis of the upper limb, which may be partial or total. Hand function is affected if the hand cannot be maintained in a useful 2 position. Upper trunk lesions of the brachial plexus (C5 and C6 or C5-6-7 injuries) generally occur due to high-energy mechanisms, mainly due to motorbike accidents, falls from heights and sports trauma), mainly affecting people in a young and productive age group. One of the first goal in the management of the flail arm is to restore arm function by primary direct nerve surgery or nerve transfer or with secondary reconstructive surgery. Indications for trapezes transfer are irreversible absence of active abduction at shoulder, passive abduction of the shoulder greater than 90," with having a strong trapezium muscle, and absence of substantial degenerative changes in the shoulder joint. Mostly nerve reconstruction/transfer is done but in absence of good results or when patients present with lapse of golden period, then muscle transfer surgeries, are planned. A number of tendon transfers have been described to replace the function of the 2,3,4,5 deltoid. Transfer of the trapezium insertion was first 5 described by Mayer, who used a fascia lat graft to extend its attachment to the deltoid tuberosity. 6 Bateman modified the procedure by advising resection of part of the spine of the scapula with the trapezium, to allow screw fixation of the transfer to the hummers. This procedure was further modified 7 by Saha. This study was planned to assess the outcome of Saha’s procedure on the improvement of movement at shoulder joint, with brachial plexus injuries. METHODOLOGY This quasi experimental study was conducted on 12 patients. The patients selected had traumatic lesions of the upper trunk of the brachial plexus (C5 and C6 with or without impairment of C7) who came st st between 1 January 2011 to 31 December 2014. All the patients were operated at National Orthopedic Hospital, Bahawalpur. The functional evaluations were carried out in the pre- and postoperative periods after 90 days and in the six month after surgery up to 2 years. The functional evaluation (Clinical) was done Original Article JSZMC Vol.8 No.4 1277 1. Department of Orthopaedics, QAMC/BVH, Bhawalpur, University of Health Sciences Lahore, Pakistan. Correspondence: Dr. Muhammad Javed, Department of Orthopaedics, QAMC/BVH, Bhawalpur, Pakistan Phone: +92-3009688616 Received: 22-08-2017 Accepted: 25-09-2017