LATE TREATMENT OF BRACHIAL-PLEXUS PALSY SECONDARY TO BIRTH INJURIES -ROTATIONAL OSTEOTOMY OF THE PROXIMAL PART OF THE HUMERUS

We retrospectively reviewed the results of rotational osteotomy that h ad been performed distal to the surgical neck of the humerus in twenty -two patients who had sustained an injury of the brachial plexus at bi rth. Eighteen patients had a lesion of the superior trunk of the brach ial plexus (the fifth and sixth cervical nerve roots), and four had in volvement of the entire brachial plexus. The patients ranged in age fr om four to seventeen years old (average age, ten years and three month s old) at the time of the operation, The average duration of follow-up was fourteen years (range, two to thirty-one years). Preoperatively, the patients had been unable to perform self-care activities, such as grooming, feeding, and washing themselves, because of limited active e xternal rotation or fixed internal rotation of the shoulder All patien ts had decreased strength of the lateral rotator and abductor muscles and normal strength of the subscapularis and pectoralis major muscles. Radiographs showed some flattening of the humeral head, and four pati ents had posterior subluxation of the humeral head, A lateral rotation al osteotomy of the proximal part of the humerus was performed between the insertions of the subscapularis and pectoralis major muscles. The site of the osteotomy was stabilized,vith catgut sutures in the perio steum in ten patients and with one or two staples in twelve. The extre mity was immobilized in a plaster shoulder-spica cast for six weeks. A t the latest follow-up evaluation, the average increase in active abdu ction was 27 degrees (range, ii to 60 degrees) and the average increas e in the are of rotation was 25 degrees (range, 5 to 85 degrees). Supi nation of the forearm also had increased commensurate with the increas e in external rotation. The appearance of the extremity had improved a s well.