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Sprengel's deformity correction by vertical scapular osteotomy in a paediatric age group: influence of rib cage
Anil Agarwal1,2, Madegowda Arkesh3, Gourav Jandial3
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India. rachna_anila@yahoo.co.in.
Introduction:
Vertical scapular osteotomy (VSO) is a known procedure for Sprengel's shoulder deformity. Its surgical results in the presence of rib cage anomalies largely remain unreported.
Material And Methods:
The influence of simple and complex rib anomalies on shoulder abduction, Cavendish grade, and radiological Rigault's score following VSO was studied retrospectively in eight paediatric patients. The omovertebral bar effect on surgical outcome was also observed.
Results:
The average age at surgery was 6.8 years. Rib anomalies were found in seven patients among which four had simple (50%) and three complex rib anomalies (37.5%). At mean post-surgery follow-up of four years, the overall average gain in shoulder abduction was 21°. In patients having either no or simple rib anomalies (n = 5), the mean pre-operative abduction and follow-up increase was more (132°; gain 28°) compared to complex rib anomalies (110°; gain 10°). The overall average pre-operative Cavendish score changed from 2.8 to 1.5. The correction was more complete in simple or no rib anomalies. The mean preoperative Rigault score was 2.25 with only a small improvement (0.38) noted in follow-up. Two patients with omovertebral bar attained good cosmetic and functional results.
Conclusions:
The current study was at variance with the previously published studies in terms of improved shoulder abduction following VSO especially complex rib anomalies. The omovertebral bar was not an adverse prognosticating factor.