Combined glenoid osteotomy with tendon transfers is a new alternative procedure for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy.
Step 1: MRI or CT for Preoperative Planning
Use axial plane MRI or CT for preoperative planning.
Step 2: Surgical Approach with Deltoid Elevation
Position the patient laterally, and undertake a posterior approach, including lateral elevation of the deltoid origin.
Step 3: Subscapularis Slide
Elevate the subscapularis from the scapula, provisionally reduce the humeral head, and apply gentle external rotation.
Step 4: Harvest of the Teres Major and Latissimus Dorsi Tendons
Incise the insertions of the teres major and latissimus dorsi from the proximal part of the humerus and perform a tenolysis.
Step 5: Posterior Approach to the Glenohumeral Joint
Open the posterior glenohumeral joint and assess overhead elevation.
Step 6: Assessment and Improvement of Abduction Contracture
Improve abduction contracture if it is marked.
Step 7: Harvest of Bone Graft
Harvest tricortical graft from the scapular spine or posterior aspect of the acromion.
Step 8: Scapular Neck Osteotomy
Undertake a posterior opening wedge osteotomy of the scapular neck.
Step 9: Posterior Opening Wedge at the Osteotomy Site
Insert the bone graft into the osteotomy site.
Step 10: Joint Closure and Infraspinatus Repair
Close the posterior aspect of the capsule and the infraspinatus.
Step 11: Transfer of the Teres Major and Latissimus Dorsi
Transfer the teres major and latissimus dorsi tendons into an osseous trough at the greater tuberosity.
Step 12: Closure and Immobilization
Repair the deltoid, close the wound in layers, and apply a shoulder spica cast.
Step 13: Postoperative Plan
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.
What to Watch For
Pitfalls & Challenges