[External rotation osteotomy of the humerus for the treatment of shoulder problems secondary to obstetric brachial plexus palsy].
OBJECTIVE
We evaluated the results of external rotation osteotomy of the humerus for the treatment of shoulder problems secondary to obstetric brachial plexus palsy.


METHODS
Forty children (24 boys, 16 girls; mean age 7.5 years; range 23 months to 14.8 years) underwent external rotation osteotomy of the humerus. Involvement was at the C5-6 roots in 11 patients, C5-6-7 roots in 19 patients, and at all the roots in 10 patients. Twenty-six patients had humeral head deformity and eight patients had posterior subluxation. The shoulder was ankylosed in one patient. Zancolli and Putti signs were positive in six and eight patients, respectively. The mean active shoulder abduction was 80 degrees (range 0 to 170 degrees ) and the mean internal rotation contracture was 27 degrees (range 10 degrees to 50 degrees ). Fourteen patients, all of whom were beyond five years of age, had an abduction contracture. Preoperative and postoperative functional evaluations were made with the use of the Mallet scale. Preoperatively, 35 shoulders had a score of II, five had a score of III. Osteotomies were performed in the proximal humerus in patients older than five years and in the mid-humerus in those without a contracture or younger than five years.


RESULTS
The mean postoperative shoulder abduction was 95.7 degrees (range 30 degrees to 170 degrees ). Internal rotation contractures improved in all the patients. Abduction contractures did not resolve in two patients in whom a mid-humeral osteotomy was performed. Postoperative Mallet scores ranged from II to V in five, six, 15, and 14 shoulders, respectively. Rotation provided by the osteotomy was lost in one patient because of a humerus fracture that occurred in a traffic accident. Passive total shoulder rotation remained unchanged following surgery. Patients having better preoperative range of motion and who were at younger ages benefited the most from surgical treatment.


CONCLUSIONS
External rotation osteotomy of the humerus must be performed at early ages before the shoulder gets stiffer.
Akinci
Metin
M
Center for Hand Surgery (Ankara El Cerrahi Merkezi), Ankara, Turkey. mikroel@ttnet.net.tr
Ay
Sadan
S
Kamiloğlu
Sinan
S
Erçetin
Omer
O
D000293:Adolescent; D001860:Bone Plates; D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004420:Dystocia; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000379:methods; D010243:Paralysis / Q000534:rehabilitation / Q000601:surgery*; D011247:Pregnancy; D011859:Radiography; D016896:Treatment Outcome