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Triplanar Humeral Osteotomy for Restoration of Midline Function in Patients With Brachial Plexus Birth Palsy
John D Jennings1, Dustin A Greenhill, Scott H Kozin
1*Department of Orthopaedic Surgery & Sports Medicine, Temple University Hospital †Shriners Hospital for Children, Philadelphia, PA.
Insights
This study introduces a novel 3-plane humeral osteotomy technique for brachial plexus birth palsy patients with residual deficits. The new method improves shoulder function and motion, offering a valuable surgical option when early interventions are not feasible.
Area of Science:
- Orthopedic surgery
- Pediatric neurology
- Biomechanical engineering
Background:
- Brachial plexus birth palsy (BPBP) often resolves spontaneously, but some patients experience permanent dysfunction.
- Early interventions like nerve transfers are effective but not suitable for all cases, leaving many with residual deficits.
- Traditional humeral osteotomies correct deformity in only one plane, limiting functional restoration.
Purpose of the Study:
- To present a novel technique for multi-planar correction of humeral deformity in BPBP patients.
- To evaluate the efficacy and safety of a mathematically calculated, single-stage humeral osteotomy in three planes.
Main Methods:
- A novel surgical technique involving a single humeral osteotomy was developed, utilizing a mathematical equation for calculated correction in three planes.
- Nine pediatric patients with residual BPBP deficits underwent the procedure.
- Follow-up included assessment of range of motion, deformity correction, and Modified Mallet scores.
Main Results:
- The technique successfully achieved correction in adduction, extension, and either internal or external rotation in all nine patients.
- Average follow-up was 35.4 months.
- One patient experienced transient radial nerve palsy; no other long-term complications were reported.
Conclusions:
- This novel 3-plane humeral osteotomy technique offers a viable solution for correcting complex residual deformities in BPBP patients.
- The procedure demonstrates promising functional improvements and a favorable safety profile, addressing limitations of traditional single-plane osteotomies.
Abstract:
Brachial plexus birth palsy resolves spontaneously in a majority of patients, however, others may have serious permanent dysfunction. Although nerve transfers or grafts are early options for treatment, many children have residual deficits or present too late for such procedures. In these patients, rotational osteotomy of the humerus may restore improved function and motion. Unfortunately, traditional humeral osteotomies only provide correction in a single plane, therefore appropriate correction of the typical residual deformity is incomplete. Here, we describe a novel technique for obtaining a calculated correction in 3 planes using a single osteotomy of the humerus on the basis of a mathematical equation. Nine patients are described here with an average of 35.4 months follow-up. Corrections were obtained in adduction, extension, and either internal or external rotation depending on the initial deformity and Modified Mallet scores were collected for each patient. There was 1 case of transient radial nerve palsy with no long-term complications overall.