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Shoulder function after medial approach and derotational humeral osteotomy in patients with brachial plexus birth

Joshua M Abzug1, Ross S Chafetz, John P Gaughan

  • 1Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.

Journal of Pediatric Orthopedics
|June 25, 2010
PubMed

Insights

Rotational humeral osteotomies using a medial approach effectively improved external rotation in children with brachial plexus birth palsy. However, surgeons must balance external rotation gains against potential losses in internal rotation for optimal midline function.

Area of Science:

  • Pediatric Orthopedics
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Brachial plexus birth palsy (BPBP) often results in internal rotation contractures of the humerus.
  • Surgical intervention, such as rotational humeral osteotomies, is considered to improve upper extremity function.

Purpose of the Study:

  • To evaluate the outcomes of external rotational humeral osteotomies performed via a medial approach in children diagnosed with brachial plexus birth palsy.
  • To assess the impact of this surgical technique on range of motion and functional scores.

Main Methods:

  • A retrospective review was conducted on pediatric patients with BPBP who underwent external rotational humeral osteotomies.
  • Presurgical and postsurgical range of motion, standard Mallet scores, and a modified Mallet score (including a sixth subscale for internal rotation) were analyzed.
  • This study is classified as a Level IV evidence study.

Main Results:

  • Twenty-three patients underwent the procedure, achieving an average rotational correction of 43.2 degrees.
  • Significant improvements were observed in the standard Mallet scores (13.8 to 16.1, P=0.002) and the modified scores (18.0 to 19.5, P=0.032).
  • Statistically significant gains in external rotation, hand-to-neck, and hand-to-mouth functions were noted, alongside significant decreases in hand-to-spine and hand-to-belly function, indicating a loss of internal rotation.

Conclusions:

  • External rotational humeral osteotomies via a medial approach are a safe and effective treatment for internal rotation contractures in BPBP.
  • The procedure enhances external rotation-related activities but requires careful consideration to avoid compromising internal rotation and midline function.
  • A modified Mallet score, incorporating a hand-to-belly assessment, offers more clinically relevant data on midline function compared to the hand-to-spine measure.
Abstract

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