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Distal Humerus External Rotation Osteotomy for Hand Position in Arthrogryposis
Lindley B Wall1, Valeri Calhoun2, Summer Roberts1
1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO; Shriners Hospital for Children, St. Louis, MO.
The Journal of Hand Surgery
|April 9, 2017
Summary
Distal humerus external rotation osteotomies (DHO) effectively correct internal arm rotation in arthrogryposis. This surgery improves hand grasp and function, leading to high patient and parent satisfaction with minimal complications.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Congenital limb differences
Background:
- Amyoplasia, a type of arthrogryposis, often presents with a reverse pronated grasp pattern.
- This abnormal positioning limits upper extremity function and daily activities.
Purpose of the Study:
- To evaluate the effectiveness of distal humerus external rotation osteotomies (DHO) in correcting internal rotation of the upper extremity in arthrogryposis.
- To assess the impact of DHO on hand opposition, grasp patterns, functional outcomes, and patient/parent satisfaction.
Main Methods:
- Retrospective review of 9 patients (14 extremities) who underwent DHO surgery for arthrogryposis between 2012 and 2014.
- Preoperative and postoperative video analysis of functional activities and upper extremity positioning.
- Assessment of functional changes using the Pediatric Outcomes Data Collection Instrument (PODCI) and parent satisfaction surveys.
Main Results:
- DHO surgery resulted in a mean improvement of 51° in upper extremity resting posture.
- Grasp patterns improved in 13 extremities, with 5 showing a complete change from palms facing away to palms facing midline.
- Postoperative PODCI Happiness scores were high (mean 89), and parents reported significant functional improvement.
Conclusions:
- Distal humerus external rotation osteotomies are effective in correcting internal rotation deformities in arthrogryposis.
- The procedure enhances hand opposition and functional capabilities with a low complication rate.
- High patient-reported outcomes and parent satisfaction underscore the benefits of DHO surgery.