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Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children
Marcin Sibiński1, Marek Synder
1Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Lodz, Drewnowska 75, 91-002, Lodz, Poland. sibinek@poczta.onet.pl
Insights
Surgical treatment involving tendon transfers and soft tissue releases significantly improves shoulder function in children with obstetric brachial plexus palsy (OBPP). Internal rotational osteotomy further enhances outcomes in severe cases.
Area of Science:
- Pediatric Orthopedics
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Children with obstetric brachial plexus palsy (OBPP) often experience shoulder deformities.
- Surgical interventions aim to correct these deformities and improve shoulder function.
Purpose of the Study:
- To evaluate the outcomes of treating shoulder deformity in OBPP using tendon transfers and soft tissue releases.
- To assess the efficacy of these procedures with and without internal rotational osteotomy.
- To explore the relationship between neurological status, age, and clinical outcomes.
Main Methods:
- A review of 25 patients (12 girls) who underwent latissimus dorsi and teres major tendon transfers to the rotator cuff.
- Internal rotation osteotomy was performed in ten patients.
- Mean patient age at operation was 3.2 years, with a follow-up of 3.8 years.
Main Results:
- The Mallet score improved by 4.7 points (p = 0.00002).
- Significant improvements in active and passive external rotation were observed (p < 0.00001).
- Internal rotation osteotomy showed significantly better active internal rotation outcomes compared to procedures without osteotomy (p = 0.03).
Conclusions:
- Soft tissue rebalancing procedures effectively enhance shoulder function in children with persistent OBPP.
- Internal rotational osteotomy, when combined with muscle transfers for severe cases, helps maintain joint stability and prevents internal rotation loosening without affecting other shoulder movements.
Introduction:
Children with obstetric brachial plexus palsy (OBPP) frequently have problems related to their shoulder. The aim of the investigation was to determine our results in treating shoulder deformity with tendon transfers and soft tissue releases with and without internal rotational osteotomy. We also evaluated the relationships between neurological status, age and selected clinical parameters.
Materials And Methods:
We reviewed data of 25 patients (12 girls) after latissimus dorsi and teres major tendon transfers to the rotator cuff. Internal rotation osteotomy was performed in ten children. The mean age of patients at the time of operation was 3.2 years (range from 10 months to 7.7 years).
Result:
Patients were followed up for a mean of 3.8 years (minimum 2 years). Mallet score improved 4.7 points at last follow-up (p = 0.00002). No patient had shoulder function deterioration. Active and passive external rotation increased significantly after operation: p < 0.00001, p < 0.00001, respectively. Statistically significant reduction in active internal rotation was noted (p = 0.04). The other movements have not statistically changed after operation. Active internal rotation difference after internal rotation osteotomy was significantly better than without osteotomy (p = 0.03). Neurological involvement and age had neither positive nor negative influence on final range of motion and outcome.
Conclusions:
Soft tissue rebalancing procedures significantly improve shoulder function in children with persistent OBPP. Addition of internal rotational osteotomy to muscle transfers for severe cases allows maintaining of stabile joint, prevents loosening of internal rotation and does not influence other movements of the shoulder.
