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. 2015 Nov 16;44(3):208-13.
doi: 10.1016/S2255-4971(15)30070-7. eCollection 2009 Jan.

SPRENGEL'S DEFORMITY: SURGICAL CORRECTION BY A MODIFIED GREEN PROCEDURE

Sandro da Silva Reginaldo  1 , Ruy Rocha de Macedo  2 , Rogério de Andrade Amaral  3 , André Luiz Passos Cardoso  4 , Helder Rocha Silva Araújo  4 , Sergio Daher  5
Affiliations

SPRENGEL'S DEFORMITY: SURGICAL CORRECTION BY A MODIFIED GREEN PROCEDURE

Sandro da Silva Reginaldo et al. Rev Bras Ortop. .

Abstract

Objective: To evaluate the cosmetic and functional results of patients submitted to surgical correction of Congenital High Scapula (Sprengel's Deformity) using modified Green's Procedure, as well as patients' satisfaction and complications.

Methods: Nine patients submitted to surgical treatment from September 1993 to April 2008 have been assessed. The modification from original technique was: subperiosteal muscle detachment, resection of superomedial scapular portion and fixation of medial portion of scapular spine to contralateral posterior iliac crest instead of skeletal traction, with subcutaneous wire. The mean age was 7 years and 3 months. The mean follow-up time was 3 years and 7 months.

Results: The mean improvement in forward elevation was 39o (range 0 to 80o). According to the Cavendish Classification, cosmetic improvement of two degrees was achieved in eight cases, and three degrees in one. All patients were satisfied with results.

Conclusions: Surgical correction of Sprengel's Deformity by a modified Green's procedure with contralateral posterior iliac crest fixation instead of skeletal traction, showed both cosmetic and functional improvements; all patients and/or family members were satisfied with the results, and the complications associated to the surgical technique did not interfere on end results.

Keywords: Scapula; Sprengel's deformity.

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Figures

Figure 1
Figure 1
Clinical changes in a Sprengel deformity. Hypoplastic and elevated left scapula (a) and limitation of elevation (b) (case 9).
Figure 2
Figure 2
Omovertebral (OV) bone. Radiographic (a) and intraoperative (b) appearance (case 6).
Figure 3
Figure 3
* Modified Green technique (case 6): a) patient in the horizontal prone position, with scapular angles marked (black dots); b) subperiosteal disinsertion of medial muscles, lowering the scapula and omovertebral (ov) bone excision; c) portion of the superior medial scapula resected (**) and steel wire attached to the scapular spine; d) subcutaneous passage of the wire to the contralateral posterior iliac crest, to which it is fixed to maintain scapular lowering; e) final surgical appearance; f,g,h) clinical aspect with six years and six months of postoperative follow-up, showing improvements in aesthetics and elevation. * Taken with author's permission from Lech O, Reginaldo SS. Deformidade de Sprengel (Escápula Alada). In: Lech O. Defeitos Congênitos nos Membros Superiores.
Figure 4
Figure 4
X-ray in the immediate postoperative period (case 8).
See this image and copyright information in PMC

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