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

Assunção, Jorge Henrique; Ferreira Neto, Arnaldo Amado; Benegas, Eduardo; Bolliger Neto, Raul; Prada, Flávia Santis; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; Camanho, Gilberto Luis

doi:10.6061/clinics/2013(07)07

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CLINICAL SCIENCES • Clinics 68 (7) • July 2013 • https://doi.org/10.6061/clinics/2013(07)07 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

METHOD:

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.

CONCLUSION:

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.

Obstetric Palsy; Glenohumeral Deformity; Shoulder Dislocation; Osteotomy

Patient	Sex	Age at time of surgery (yrs)	Follow-up (yrs)	Pre-surgery Mallet score	Post-surgery Mallet score	Gain in the Mallet score	Pre-surgery X-ray finding	Post-surgery X-ray finding
1	M	2	2	12	17	5	dislocated	centered
2	M	6	2	9	16	7	dislocated	centered
3	M	2	2	10	16	6	subluxated	centered
4	F	2	2	12	14	2	dislocated	subluxated
5	F	4	2	12	19	7	subluxated	centered
6	M	3	3	14	19	5	dislocated	subluxated
7	F	2	3	14	21	7	dislocated	centered
8	F	3	3	8	18	10	dislocated	centered
9	M	2	2	13	17	4	dislocated	centered
10	M	2	2	12	14	2	dislocated	centered
11	F	5	2	17	22	5	subluxated	centered
12	M	5	6	10	17	7	dislocated	centered
13	F	5	6	13	17	4	subluxated	centered
14	M	2	6	10	16	6	dislocated	centered
15	M	3	6	10	14	4	subluxated	Subluxated
16	M	3	6	11	14	3	dislocated	centered
17	M	5	2	10	18	8	subluxated	centered
18	F	1	7	13	20	7	subluxated	centered
19	M	3	7	14	16	2	dislocated	centered
20	F	4	7	13	14	1	dislocated	centered
21	F	6	8	10	18	8	dislocated	centered
22	M	3	8	14	20	6	subluxated	centered
23	M	1	9	11	20	9	dislocated	centered
24	M	3	9	10	13	3	dislocated	centered
25	M	3	12	10	18	8	subluxated	centered
26	F	4	2	12	16	4	subluxated	centered
27	F	6	2	13	16	3	subluxated	subluxated
28	M	8	7	13	15	2	dislocated	subluxated
29	F	9	6	11	12	1	subluxated	centered
30	F	8	2	13	15	2	dislocated	subluxated
31	M	9	5	14	14	0	dislocated	centered
32	F	7	5	12	12	0	subluxated	centered
33	M	8	3	18	18	0	dislocated	subluxated
34	M	8	4	14	15	1	subluxated	centered
35	M	7	2	13	15	2	subluxated	centered
Mean		4.4	4.6	12.14	16.46	4.32

Age	<7 years	≥7 years	All
Mean preoperative Mallet score (range)	11.61 (8-17)^* *p<0.05. )	13.66 (11-18)^* *p<0.05. )	12.14 (8-18)^* *p<0.05. )
Mean postoperative Mallet score	16.90 (14-22)^* *p<0.05. )	14.66 (12-18)^* *p<0.05. )	16.46 (12-22)^* *p<0.05. )
(range)
Mean preoperative glenoid retroversion (range)	-23.3° (-34/-12)^* *p<0.05. )	-16° (-25/-6)	-21.4° (-34/-3)^* *p<0.05. )
Mean postoperative glenoid retroversion (range)	-9.5° (-15/-6)^* *p<0.05. )	-19.4° (-32/-10)	-12° (-32/-2)^* *p<0.05. )

Mean preoperative PD Humeral Head (range)	3.1% (0-27%)^* *p<0.05. )	16.6% (10-28%)	6.5% (0-28%)^* *p<0.05. )
Mean postoperative PD Humeral Head (range)	38.8% (18.3-50%)^* *p<0.05. )	24.3% (10-30%)	35.2% (10-50%)^* *p<0.05. )

Radiographic evaluation	Preoperative (patients n)	Postoperative (patients n)
Reduced	0	28
Posterior Subluxation	15	7
Posterior Dislocation	20	0

CT evaluation	Preoperative (patients n)	Postoperative (patients n)
Waters I	0	2
Waters II	0	10
Waters III	6	4
Waters IV	1	4
Waters V	3	0
Waters VI	10	0

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

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[1] Assunção JH designed the study, wrote the text, and participated as a surgeon. Ferreira Neto AA guided the project and participated as a surgeon. Benegas E participated as a surgeon. Neto RB conducted the statistical analysis. Prada FS compiled the bibliography and participated as a surgeon. Malavolta EA served as a reviewer and participated as a surgeon. Gracitelli MEC wrote the manuscript, formatted the text and photographs, and participated as a surgeon. Camanho GL served as a reviewer.