title: Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: early outcomes.
abstract: BACKGROUND
  In the setting of severe glenohumeral dysplasia secondary to brachial plexus birth palsy, external rotation osteotomy of the humerus has traditionally been used to transpose the existing arc of shoulder motion to a more functional position. Here we introduce a surgical alternative, the aim of which is to gain stable reduction of the shoulder and restore active external rotation.
  
  
  METHODS
  All patients with brachial plexus birth palsy and Waters type-III, IV, or V glenohumeral dysplasia who underwent glenoid anteversion osteotomy combined with tendon transfers between 2006 and 2009 were identified. The Mallet score, Active Movement Scale, and active and passive ranges of motion were used to assess functional outcomes. Axial imaging was used to measure glenoid version, the degree of subluxation, and the Waters type.
  
  
  RESULTS
  Thirty-two patients with a median age of 6.8 years (range, 2.1 to 16.2 years) were followed for a mean of twenty months (range, twelve to twenty-nine months). On average, passive external rotation with the shoulder in neutral increased by 43° (95% confidence interval [CI], 26° to 60°), passive internal rotation decreased by 22° (95% CI, 12° to 31°), active external rotation with the shoulder in neutral increased by 82° (95% CI, 66° to 98°), and active internal rotation decreased by 26° (95% CI, 14° to 38°). The aggregate Mallet score improved by a mean of 4.0 points (95% CI, 3.0 to 4.9). Glenoid retroversion improved by a mean of 26° (95% CI, 20° to 32°). The percentage of the humeral head anterior to the midscapular line improved by a mean of 35% (95% CI, 30% to 40%).
  
  
  CONCLUSIONS
  In patients with severe glenohumeral dysplasia, glenoid realignment osteotomy in conjunction with soft-tissue rebalancing permits maintenance of joint reduction and functional improvement in the short term. In our view, external rotation osteotomy of the humerus is no longer the only surgical option for these cases.
authors.affiliation: Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. dodwelle@hss.edu
authors.forename: Emily
authors.initials: E
authors.lastname: Dodwell
authors.forename: Jamie
authors.initials: J
authors.lastname: O'Callaghan
authors.forename: Alison
authors.initials: A
authors.lastname: Anthony
authors.forename: Paul
authors.initials: P
authors.lastname: Jellicoe
authors.forename: Maulin
authors.initials: M
authors.lastname: Shah
authors.forename: Christine
authors.initials: C
authors.lastname: Curtis
authors.forename: Howard
authors.initials: H
authors.lastname: Clarke
authors.forename: Sevan
authors.initials: S
authors.lastname: Hopyan
mesh_terms: D000293:Adolescent; D001720:Birth Injuries / Q000150:complications / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D018709:Statistics, Nonparametric; D013709:Tendon Transfer / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome