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Case Reports
. 2018 Jan;52(1):75-80.
doi: 10.1016/j.aott.2017.03.019. Epub 2017 May 8.

Late treatment of obstetrical brachial plexus palsy by humeral rotational osteotomy and lengthening with an intramedullary elongation nail

Ahmet Emrah Acan  1 , Onur Gursan  2 , Nihat Demirhan Demirkiran  2 , Hasan Havitcioglu  2
Affiliations
Case Reports

Late treatment of obstetrical brachial plexus palsy by humeral rotational osteotomy and lengthening with an intramedullary elongation nail

Ahmet Emrah Acan et al. Acta Orthop Traumatol Turc. 2018 Jan.

Abstract

To date, all the authors who have recommended external rotation osteotomy (ERO) in the late treatment of obstetrical brachial plexus palsy (OBPP), have neglected upper limb length discrepancy, which is an another sequelae of OBPP. In this paper, a new technique is reported for the late treatment of OBPP patients with upper limb length discrepancy, in which both humeral external rotation osteotomy (ERO) and lengthening are applied with an intramedullary elongation nail. With this technique, upper limb function is improved through re-orientation of the shoulder arc to a more functional range, and further improvements will be seen in the appearance of the upper limb with the elimination of length discrepancy. It is also advocated that there is a potentiating effect of the humeral lengthening on shoulder movements gained by ERO when the osteotomy is applied above the deltoid insertion, as this allows more lateralized placement of the deltoid insertion.

Keywords: Elongation nail; Humeral lengthening; Lengthening nail; Obstetrical brachial plexus palsy.

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Figures

Fig. 1
Fig. 1
a, b: Pre-operative AP and Lat. X-rays.
Fig. 2
Fig. 2
a, b: Post-operative plain AP and Lat. X-rays.
Fig. 3
Fig. 3
a, b: At the end of 5 cm distraction, AP and Lat. X-rays.
Fig. 4
Fig. 4
a, b: After 3 months, AP and Lat. X-rays.
Fig. 5
Fig. 5
a, b: At 9 months. AP and Lat. X-rays.
Fig. 6
Fig. 6
Range of motions at 36 months.
See this image and copyright information in PMC

References

    1. Kay S.P. Obstetrical brachial palsy. Br J Plast Surg. 1998 Jan;51(1):43–50. doi: 10.1054/bjps.1997.0166. - DOI - PubMed
    1. Pondaag W., Malessy M.J., van Dijk J.G., Thomeer R.T. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004 Feb;46(2):138–144. doi: 10.1111/j.1469-8749.2004.tb00463.x. - DOI - PubMed
    1. Kirkos J.M., Papadopoulos I.A. Late treatment of brachial plexus palsy secondary to birth injuries: rotational osteotomy of the proximal part of the humerus. J Bone Jt Surg Am. 1998 Oct;80(10):1477–1483. doi: 10.2106/00004623-199810000-00009. - DOI - PubMed
    1. Waters P.M., Smith G.R., Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Jt Surg Am. 1998 May;80(5):668–677. doi: 10.2106/00004623-199805000-00007. - DOI - PubMed
    1. Al-Qattan M.M. Rotation osteotomy of the humerus for Erb's palsy in children with humeral head deformity. J Hand Surg Am. 2002 May;27(3):479–483. doi: 10.1053/jhsu.2002.33198. - DOI - PubMed

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