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Percutaneous humeral derotational osteotomy in obstetrical brachial plexus palsy: a new technique
1Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium.
Insights
A new percutaneous humeral osteotomy technique offers a safe and effective alternative for treating shoulder contractures in children with obstetrical brachial plexus palsy, improving shoulder function.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pediatric Rehabilitation
Background:
- Obstetrical brachial plexus palsy (OBPP) can lead to shoulder internal contracture and osseous deformity in children with incomplete neurological recovery.
- Traditional surgical treatment involves open humeral derotational osteotomy with plate fixation, posing risks like scarring, nonunion, and nerve palsy, often requiring hardware removal.
Observation:
- Children with OBPP and shoulder deformity often require surgical intervention.
- The classical open osteotomy technique has known complications and drawbacks.
Findings:
- A novel percutaneous humeral osteotomy using a Hoffmann external fixator was performed in six children.
- Bone healing was achieved in an average of 45 days with no adverse complications.
- Postoperative outcomes demonstrated improved shoulder function.
Implications:
- Percutaneous humeral osteotomy is a simpler, safer alternative to open surgery for OBPP sequelae.
- This technique avoids the risks associated with traditional plate fixation and longitudinal scarring.
- It presents a valuable new treatment option for improving shoulder function in affected children.
Abstract:
Thirty three per cent of children with obstetrical brachial plexus palsy with incomplete neurological recovery develop shoulder internal contracture associated with osseous deformity. Some of the older children are treated by humeral derotational osteotomy. The classical technique of open approach to the humeral diaphysis and plate fixation imposes a longitudinal scar and carries significant risks (nonunion, nerve palsy); a secondary procedure for plate removal is necessary in a significant proportion of patients. The authors report a new technique of percutaneous humeral osteotomy with osteosynthesis by Hoffmann external fixator. In six cases bone healing was obtained at an average of 45 days, without adverse complication. The postoperative results showed improved shoulder function. This new technique is simple and safe; it represents a new option for the treatment of sequelae of obstetrical brachial plexus palsy.
