Correction of internal rotation of the shoulder in erb’s palsy by tendon transfer versus derotational osteotomy

Abstract EN

Objective: The aim of the study is to evaluate the functional results of the shoulder joint in patients with brachial plexus injury by tendon transfer versus derotational osteotomy of the humerus.

Patients and methods: This study included 10 patients (6 males and 4 females) who attended to the outpatient clinic in the Suez Canal University hospital during the period from May 2004 to January 2006.

The patients ranged in age from 4-7 years old (average age 5 years and three months).

Right shoulder was affected in 7 patients and 3 in left shoulder.

We divided them into two equal groups of patients the first group managed with tendon transfer and the second group with derotational osteotomy of the proximal part of the humerus.

Functional evaluation was done preoperatively and postoperatively for each patient with recording of the passive and active range of motion with determination of active range of motion of the shoulder.

The functional ability of the involved shoulder was evaluated with use of modification of Mallet classification system*6).

Results: At the time of follow-up after one year, In the first group of patients managed by tendon transfer with using mallet classification, , the average value was 4.0 for global abduction, 4.6 for global external rotation, 4.2 for the ability to bring the hand to the neck, and 4.2 for the ability to bring the hand to the mouth.

The average passive external rotation at 90 degrees of shoulder abduction was 19 degrees (range, 10-30 degrees) on the affected side.

There was significant postoperative improvement in all of the measured parameters (P < 0.0005) In the second group of patients managed by derotational osteotomy of the humerus the average value was 4.6 for global abduction, 4.2 for global external rotation, 4.6 for the ability to bring the hand to the neck and 4.6 for the ability to bring the hand to the mouth.

The average post-operative value for passive external rotation at 90 degrees of shoulder abduction was 33 degrees (range 20 to 40 degrees) on the affected side.

The post-operative improvement in all Mallet classes and in passive external rotation was significant (P<0.0005).

Complications occurred in only one patient (case 3 in group one) had a superficial wound infection which was successfully treated by debridement within two weeks.

Conclusion: We recommend using the tendon transfer technique with a single anterior approach without a posterior approach to the triceps muscle as an easy technique with a good functional result.

Also, we recommend using the derotational osteotomy technique in younger patients for its better functional results according to Mallet classification system and early movement without need for shoulder spica for six weeks as in tendon transfer procedure