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Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth Palsy
Emily Dodwell, MD, MPH, FRCSC1; Sevan Hopyan, MD, PhD, FRCSC2
1 Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021. E-mail address: dodwelle@hss.edu
2 Division of Orthopaedic Surgery, Hospital for Sick Children, Room S107, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: sevan.hopyan@sickkids.ca
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Based on an original article: J Bone Joint Surg Am. 2012 Dec 5;94(23):2145-52



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Dec 12;2(4):e23 1-13. doi: 10.2106/JBJS.ST.L.00021
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Extract

Overview
Introduction

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.

Results

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

Indications

Contraindications

Pitfalls & Challenges

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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