Background: Derotational humeral osteotomies have been used in older
children with brachial plexus birth palsy and glenohumeral joint deformity to
place the upper extremity in a more functional position. The purpose of this
study was to determine the effects of these procedures on shoulder function
and joint morphology.
Methods: Forty-three patients underwent a derotational humeral
osteotomy for functional impairment in the setting of internal rotation
contracture and/or glenohumeral joint deformity at our institution from 1996
to 2004. Osteotomies were performed proximal to the deltoid insertion and were
stabilized with plate-and-screw fixation. The average age of the patients at
the time of surgery was 7.6 years (range, 2.3 to 17.0 years). Shoulder
function was graded according to the modified Mallet classification system.
Glenohumeral deformity was graded according to the classification scheme of
Waters et al. The results for twenty-seven patients who were followed for a
minimum of two years (average, 3.7 years) are reported.
Results: The average amount of external rotation achieved with
osteotomy was 64° (range, 35° to 90°). The mean aggregate Mallet
classification score improved from 13 to 18 points (p < 0.01). The mean
Mallet classification scores for the individual elements similarly
demonstrated improvement following osteotomy, with the greatest gains in
hand-to-mouth, hand-to-neck, and external rotation motions. The mean
classification of the glenohumeral deformity was type IV preoperatively and
postoperatively, signifying the persistence of glenohumeral dysplasia. There
were no nonunions. One patient required a revision osteotomy for inadequate
initial correction. One patient sustained a humeral fracture distal to the
plate fixation because of sports-related trauma.
Conclusions: Derotational humeral osteotomy improves shoulder
function in patients with brachial plexus birth palsy, internal rotation
contracture, and/or advanced glenohumeral joint deformity. This osteotomy
provides an attractive treatment option for patients with brachial plexus
birth palsy who have advanced glenohumeral dysplasia precluding soft-tissue
releases and tendon transfers.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.