Humeral internal rotation osteotomy for the treatment of Erb-Duchenne-type obstetric palsy: clinical and radiographic results

• Published in: Clinics (São Paulo, Brazil) Vol. 68; no. 7; pp. 928 - 933
• Main Authors: Assunção, Jorge Henrique, Neto, Arnaldo Amado Ferreira, Benegas, Eduardo, Neto, Raul Bolliger, Prada, Flávia Santis, Malavolta, Eduardo Angeli, Gracitelli, Mauro Emilio Conforto, Camanho, Gilberto Luis
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-07-2013; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Age Factors; Brachial Plexus Neuropathies - diagnostic imaging; Brachial Plexus Neuropathies - surgery; Child; Child, Preschool; Clinical Science; Female; Follow-Up Studies; Glenohumeral Deformity; Humans; Humeral Head - diagnostic imaging; Humeral Head - surgery; Infant; Male; MEDICINE, GENERAL & INTERNAL; Obstetric Palsy; Osteotomy; Osteotomy - methods; Postoperative Period; Preoperative Period; Recovery of Function; Rotation; Shoulder Dislocation; Shoulder Joint - diagnostic imaging; Shoulder Joint - surgery; Tomography, X-Ray Computed; Treatment Outcome; Osteotomy; Obstetric Palsy; Glenohumeral Deformity; Shoulder Dislocation
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2013(07)07

To evaluate the functional and radiographic results in patients undergoing shoulder anterior soft tissue stretching in association with open reduction and internal rotation osteotomy to centralize the humeral head as a treatment for Erb-Duchenne obstetric palsy sequelae.
A total of 35 patients underwent this surgical treatment, and the mean follow-up was 4.6 years. The Mallet scale was applied before and after the surgical procedure. A total of 20 patients underwent computed tomography to assess the glenoid version and humeral head subluxation.
Functional improvement was achieved, as evidenced by an increase in the Mallet scale score from 12.14 to 16.46 (p<0.001). The correction of retroversion was achieved once the glenoid version ranged from -21.4 to -12 degrees (p<0.001). The humeral head subluxation improved from 6.5 to 35.2% (p<0.001). Patients older than 6 years of age did not achieve glenohumeral joint improvement with respect to dysplastic abnormalities.
Internal rotation osteotomy in association with the stretching of anterior soft tissues of the shoulder in patients under the age of 7 years provided improvements in the function, retroversion, and subluxation of the glenohumeral joint.