Essential Surgical Techniques
Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth Palsy
Emily Dodwell, MD, MPH, FRCSC; Sevan Hopyan, MD, PhD, FRCSC


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 …

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