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

Abstract

Combined glenoid osteotomy with tendon transfers is a new alternative procedure for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy. Use axial plane MRI or CT for preoperative planning. Position the patient laterally, and undertake a posterior approach, including lateral elevation of the deltoid origin. Elevate the subscapularis from the scapula, provisionally reduce the humeral head, and apply gentle external rotation. Incise the insertions of the teres major and latissimus dorsi from the proximal part of the humerus and perform a tenolysis. Open the posterior glenohumeral joint and assess overhead elevation. Improve abduction contracture if it is marked. Harvest tricortical graft from the scapular spine or posterior aspect of the acromion. Undertake a posterior opening wedge osteotomy of the scapular neck. Insert the bone graft into the osteotomy site. Close the posterior aspect of the capsule and the infraspinatus. Transfer the teres major and latissimus dorsi tendons into an osseous trough at the greater tuberosity. Repair the deltoid, close the wound in layers, and apply a shoulder spica cast. Maintain the spica cast for five to six weeks; then initiate physiotherapy. In our series of thirty-two patients with severe glenohumeral dysplasia who underwent combined glenoid osteotomy and tendon transfers, early results suggest that the outcomes of this procedure are similar to those of proximal humeral external rotation osteotomy¹. IndicationsContraindicationsPitfalls & Challenges.