title: Humeral internal rotation osteotomy for the treatment of Erb-Duchenne-type obstetric palsy: clinical and radiographic results.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Jorge Henrique
authors.initials: JH
authors.lastname: Assunção
authors.forename: Arnaldo Amado Neto
authors.initials: AA
authors.lastname: Ferreira
authors.forename: Eduardo
authors.initials: E
authors.lastname: Benegas
authors.forename: Raul Neto
authors.initials: RN
authors.lastname: Bolliger
authors.forename: Flávia Santis
authors.initials: FS
authors.lastname: Prada
authors.forename: Eduardo Angeli
authors.initials: EA
authors.lastname: Malavolta
authors.forename: Mauro Emilio Conforto
authors.initials: ME
authors.lastname: Gracitelli
authors.forename: Gilberto Luis
authors.initials: GL
authors.lastname: Camanho
mesh_terms: D000367:Age Factors; D020516:Brachial Plexus Neuropathies / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D020127:Recovery of Function; D012399:Rotation; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
references.citation: J Bone Joint Surg Am. 2005 Feb;87(2):320-5
references.pmid: 15687154
references.citation: Arch Orthop Trauma Surg. 2010 Dec;130(12):1499-504
references.pmid: 20217107
references.citation: J Bone Joint Surg Am. 2003 Sep;85(9):1733-8
references.pmid: 12954832
references.citation: J Hand Surg Am. 2010 Feb;35(2):322-31
references.pmid: 20141905
references.citation: J Bone Joint Surg Am. 1998 May;80(5):668-77
references.pmid: 9611027
references.citation: J Pediatr Orthop. 2003 Jan-Feb;23(1):109-13
references.pmid: 12499955
references.citation: J Bone Joint Surg Am. 1992 Aug;74(7):1032-7
references.pmid: 1522089
references.citation: J Bone Joint Surg Br. 2005 Feb;87(2):231-5
references.pmid: 15736749
references.citation: J Bone Joint Surg Br. 1989 Nov;71(5):764-6
references.pmid: 2684988
references.citation: J Hand Surg Am. 2002 May;27(3):479-83
references.pmid: 12015723
references.citation: J Bone Joint Surg Am. 2006 May;88(5):1035-42
references.pmid: 16651578
references.citation: Microsurgery. 2008;28(2):108-12
references.pmid: 18213572
references.citation: J Bone Joint Surg Br. 2006 Feb;88(2):213-9
references.pmid: 16434527
references.citation: J Bone Joint Surg Br. 2002 May;84(4):583-7
references.pmid: 12043783
references.citation: Chirurgie. 1984;110(1):70-5
references.pmid: 6734350
references.citation: J Am Acad Orthop Surg. 2009 Apr;17(4):242-54
references.pmid: 19307673
references.citation: J Pediatr Orthop B. 2006 Sep;15(5):324-7
references.pmid: 16891958
references.citation: J Shoulder Elbow Surg. 2007 Jan-Feb;16(1):6-13
references.pmid: 17055299