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Scientific Articles   |    
Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth PalsyEarly Outcomes
Emily Dodwell, MD, MPH, FRCSC1; Jamie O’Callaghan, BSc2; Alison Anthony, BScPT3; Paul Jellicoe, MBChB, LLM(Med Law), FRCSC4; Maulin Shah, MBBS, MS(Orth), DNB(Orth)5; Christine Curtis, BScPT, MSc3; Howard Clarke, MD, PhD, FRCSC6; Sevan Hopyan, MD, PhD, FRCSC2
1 Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021. E-mail address: dodwelle@hss.edu
2 Division of Orthopaedic Surgery, Hospital for Sick Children, Room S107, 555 University Avenue, Toronto, ON M5G 1X8, Canada
3 Rehabilitation Services, Hospital for Sick Children, Room S229, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address for A. Anthony: alison.anthony@sickkids.ca. E-mail address for C. Curtis: chris.curtis@sickkids.ca
4 Paediatric Orthopaedics, Department of Orthopedics, AD401-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada. E-mail address: pjellicoe@exchange.hsc.mb.ca
5 OrthoKids Clinic, 2nd Floor, Kamdhenu House, Opp. Apang Manav Mandal, Drive-in Road, Memnagar, Ahmedabad 380 052 Gujarat, India. E-mail address: orthokidsclinic@gmail.com
6 Division of Plastic Surgery, Hospital for Sick Children, Room 5452, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: howard.clarke@utoronto.ca
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  • Disclosure statement for author(s): PDF

Investigation performed at the Hospital for Sick Children, Toronto, Ontario, Canada



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Dec 05;94(23):2145-2152. doi: 10.2106/JBJS.K.01256
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Abstract

Background: 

In the setting of severe glenohumeral dysplasia secondary to brachial plexus birth palsy, external rotation osteotomy of the humerus has traditionally been used to transpose the existing arc of shoulder motion to a more functional position. Here we introduce a surgical alternative, the aim of which is to gain stable reduction of the shoulder and restore active external rotation.

Methods: 

All patients with brachial plexus birth palsy and Waters type-III, IV, or V glenohumeral dysplasia who underwent glenoid anteversion osteotomy combined with tendon transfers between 2006 and 2009 were identified. The Mallet score, Active Movement Scale, and active and passive ranges of motion were used to assess functional outcomes. Axial imaging was used to measure glenoid version, the degree of subluxation, and the Waters type.

Results: 

Thirty-two patients with a median age of 6.8 years (range, 2.1 to 16.2 years) were followed for a mean of twenty months (range, twelve to twenty-nine months). On average, passive external rotation with the shoulder in neutral increased by 43° (95% confidence interval [CI], 26° to 60°), passive internal rotation decreased by 22° (95% CI, 12° to 31°), active external rotation with the shoulder in neutral increased by 82° (95% CI, 66° to 98°), and active internal rotation decreased by 26° (95% CI, 14° to 38°). The aggregate Mallet score improved by a mean of 4.0 points (95% CI, 3.0 to 4.9). Glenoid retroversion improved by a mean of 26° (95% CI, 20° to 32°). The percentage of the humeral head anterior to the midscapular line improved by a mean of 35% (95% CI, 30% to 40%).

Conclusions: 

In patients with severe glenohumeral dysplasia, glenoid realignment osteotomy in conjunction with soft-tissue rebalancing permits maintenance of joint reduction and functional improvement in the short term. In our view, external rotation osteotomy of the humerus is no longer the only surgical option for these cases.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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