Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth Palsy Early Outcomes

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 degrees (95% confidence interval [Cl], 26 degrees to 60 degrees), passive internal rotation decreased by 22 degrees (95% CI, 12 degrees to 31 degrees), active external rotation with the shoulder in neutral increased by 82 degrees (95% Cl, 66 degrees to 98 degrees), and active internal rotation decreased by 26 (95% CI, 14 degrees to 38 degrees). 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 degrees (95% Cl, 20 degrees to 32 degrees). The percentage of the humeral head anterior to the midscapular line improved by a mean of 35% (95% Cl, 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.