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Changing glenoid version after open reduction of shoulders in children with obstetric brachial plexus palsy
1Royal Children's Hospital, Melbourne, Australia.
Insights
Open reduction surgery for obstetric brachial plexus palsy improved shoulder joint congruity. Glenoid retroversion significantly decreased post-surgery, indicating improved shoulder stability in affected children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Neuromuscular disorders
Background:
- Obstetric brachial plexus palsy (OBPP) frequently causes shoulder subluxation/dislocation.
- Glenoid version abnormalities are common in OBPP, impacting glenohumeral joint stability.
- Surgical intervention is often necessary for severe cases.
Purpose of the Study:
- To prospectively evaluate changes in glenoid version after open reduction and tendon lengthening surgery in pediatric patients with OBPP.
- To assess the long-term effects of surgery on glenohumeral joint congruity and glenoid version.
Main Methods:
- Prospective study of 23 patients with OBPP and shoulder instability undergoing open reduction and tendon lengthening.
- Preoperative and serial postoperative computed tomography (CT) scans of the shoulders were performed.
- Glenoid version and glenohumeral joint congruity were assessed at yearly intervals.
Main Results:
- Mean glenoid retroversion in the affected shoulder progressively decreased after surgery.
- The difference in glenoid version between the affected and normal shoulder diminished.
- Glenoid retroversion decreased by a mean of 31% initially, with continued improvement of 9% per year.
Conclusions:
- Open reduction and tendon lengthening surgery is effective in correcting glenoid retroversion in pediatric patients with OBPP.
- The surgical procedure leads to improved glenohumeral joint congruity and long-term stability.
- This surgical approach offers significant benefits for managing shoulder instability secondary to OBPP.
Abstract:
Twenty-three patients who had obstetric brachial plexus palsy and shoulder subluxation or dislocation that required open reduction and tendon lengthening were entered into a prospective study to evaluate glenoid version after surgery. All the patients had a preoperative computerized axial tomograph and postoperative computed tomography scan of both shoulders at approximately yearly intervals to assess the degree of congruity of the glenohumeral joint and glenoid version. Surgery was performed between 1988 and 1997. There were 11 girls and 12 boys. The mean age was 2 years 5 months (range 8 months-6 years 7 months). The left shoulder was affected in 12 patients and the right shoulder was affected in 11 patients. At mean follow-up of 3 years 7 months, the mean glenoid retroversion for the dislocated shoulder progressively decreased. The difference in glenoid version between the dislocated and the normal side decreased. The angle of glenoid retroversion in the affected shoulders decreased by a mean of 31% after open reduction, and the retroversion continued to improve at 9% per year.
