Derotational Osteotomies for The Late Treatment of Brachial Plexus Injury

Obstetric brachial plexus palsy [OBBP] can affect the function of the upper extremity. Most of the injuries are limited to the upper spinal nerves and heals spontaneously. However, some of them will have incomplete recovery after OBBP often results in weakness of the external rotators [teres minor and infraspinatus] muscles compared to the internal rotators [teres major, pectoralis major, latissimus dorsi] muscles. The predominance of the internal rotators and adductor muscles over external rotators leads to an internal rotation contracture. The development of internal rotational deformity may progress to increased glenoid retroversion and posterior humeral head subluxation. If the surgeon does not repair internal rotation deformity, the humeral head is forced into a posterior position causing a complete posterior dislocation. Many procedures are performed to treat these deformities: In the young child, improving the remodeling of the glenohumeral joint, capsulectomy, and subscapular release are introduced. Tendon transfers of the shoulder have good results for motion but fail to restore the glenohumeral joint. The failure of improving joint alignment may represent the loss in clinical improvement over time. In older children, a humeral osteotomy can be an alternative to realign the limb into external rotation, improve appearance, and enhance eating, washing hair, and scratching the back of the neck. We will discuss all the techniques along with their advantages and disadvantages.