Aims: The most common contracture secondary to brachial plexus birth injury in the shoulder is the internal rotation-adduction one. The purpose of this study was to report the long-term results of the anterior shoulder release combined with transfer of the teres major and latissimus dorsi muscles posteriorly and laterally to allow them to act as external rotators. Methods: The described surgical procedure was performed in ten patients. Nine of them were male and one female, while eight patients had a lesion of the superior trunk and two had involvement of the entire brachial plexus. The patientsñ age ranged from 5 to 9 years old (av. age: 6 years) at the time of the operation, while the average follow-up time was 30 years (range, 25 to 42 years). Results: No improvement of the active abduction was noticed in any of the patients. The average increase of the active external rotation, which had postoperatively been achieved, was 35¡ and was maintained for an average time of 10 years, after which in eight of them gradually began to reduce. At the end of the second postoperative decade the active external rotation of the arm ranged from -10¡ to 5¡. Conclusions: The satisfactory early results of the described surgical procedure are not permanent. The þnal long-term result was the loss of the initial postoperative active external rotation possibly due to the gradually increasing degeneration of the transferred muscles.

We treated 49 patients at an average age of 80 years (75 to 90) with distal mostly intraarticular humeral fractures by open reduction. There were 8 class A, 13 class B and 28 class C fractures on Muller's classification. The patients were reviewed at a postoperative average of 18 months. The patients' assessment of the result was very good in 31%, good in 49%, fair in 15% and poor in 5%. The flexion-extension range was very good in 41%, good in 44% and fair in 15%. The incidence of implant failure, pseudarthrosis of the olecranon osteotomy and ulnar nerve lesion was no higher in these elderly patients than in younger patients. Old age is not a contraindication to open reduction and internal fixation; it is important to restore full function.