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The Mallet grading remains the most commonly used system in several obstetric brachial plexus centers [ 4– 6].
The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy.
In 10 cases (20%), the Mallet grading system could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n = 7) or vice versa (n = 3).
There are different methods of scoring shoulder abduction/external rotation of the shoulder such as the Toronto muscle grading system [ 2], the King Saud University grading system [ 3], and the Mallet grading system (Table 1).
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The authors noted that the Mallet score could not be applied to several children with obstetric ERb's palsy mainly because there is a discrepancy in the Mallet grade of shoulder abduction and the grade of shoulder external rotation.
The most unusual case was Case ≠ 7 (Table 2) in whom shoulder abduction was normal (Grade V) while the Mallet grade of shoulder external rotation was only Grade II.
The modified Mallet classification ("Mallet score") (Mallet 1972, Waters 1997) was used as the main outcome measure.
One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation.
In the Mallet score, 5 shoulder movements are graded on a scale from 1 (no motion) to 5 (normal motion equal to that in the unaffected side), resulting in a maximum total score of 25.
In contrast, two out of 10 patients in the nerve transfer and grafting group achieved a full recovery of shoulder and elbow motion range, and five patients reached a Mallet IV grading.
In seven of the 10 children in whom the Mallet score could not be applied to, shoulder abduction grade was better than the grade of shoulder external rotation.
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