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

Abstract

To date, all the authors who have recommended external rotation osteotomy (ERO) in the late treatmentof obstetrical brachial plexus palsy (OBPP), have neglected upper limb length discrepancy, which is ananother sequelae of OBPP. In this paper, a new technique is reported for the late treatment of OBPPpatients 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 limbfunction is improved through re-orientation of the shoulder arc to a more functional range, and furtherimprovements will be seen in the appearance of the upper limb with the elimination of lengthdiscrepancy. It is also advocated that there is a potentiating effect of the humeral lengthening onshoulder movements gained by ERO when the osteotomy is applied above the deltoid insertion, as thisallows more lateralized placement of the deltoid insertion.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).