[External rotation osteotomy of the humerus for treatment of external rotation deficit in palsies].
OBJECTIVE
Aim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder.


METHODS
Palsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face.


METHODS
Not completed rehabilitation after a neurosurgical procedure. Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation.


METHODS
To improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30-60 degrees ). A dynamic compression plate is used for osteosynthesis.


METHODS
Immobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed.


RESULTS
The procedure was performed in 15 cases, followed up on average after 3 years (0.5-8.7 years). In all cases, the shifted arc of rotation (preoperative 37 degrees deficit of external rotation, postoperative 46 degrees increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.
Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Agnes-Karll-Krankenhaus Laatzen/Klinikum Region Hannover, Hannover. oliver.ruehmann@krh.eu
Oliver
O
Rühmann
Wolfram
W
Lipka
Michael
M
Bohnsack
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D002648:Child; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010291:Paresis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000294:innervation / Q000503:physiopathology*