A few questions about Humeral Osteotomies

[Allison]

I am doing some research on humeral osteotomies. Thanks for taking the time to answer my questions:

How long ago did your child have a humeral osteotomy? and at what age did he/she have it done?
Why did your child need an osteotomy? Internal rotation? and if so, how bad was the internal rotation?
Has the new positioning held or does internal rotation pull it back to its original position eventually?
Did it have to be redone and if so, when did you start seeing that need?
Was the plate removed or kept in? Any problems with the plate and screws? Was it removed in the O.R. under general anesthesia?
How long was your child in a cast? What type of cast was it?
What results were seen immediately after the cast was removed and was there a lot of therapy necessary to begin to use the new positioning?
What restrictions were there and for how long? Sports allowed?
How did your child feel about having his/her arm in a completely new position? Were they happy or upset about it? Did it take them a long or short time to get used to their arm being so different?
Are you happy with your choice to do it or in hindsight was it not the best approach?

Here is my email address if you are more comfortable emailing me
pixiedust@rcn.com
Thanks!

[admin]

PLEASE, CAN SOMEONE SHARE WITH US THIS INFO???? I NEED ANSWERS ALSO! ANY PART OF YOUR EXPERIENCE WILL BE GREATLY APPRECIATED!!!!THANKS

[blakesmom]

my son was 7 when he had the humeral osteotomy done 1 1/2 yrs ago. It was the easiest of any of the surgeries, only was in OR for 1 hour, done outpatient. The arm was casted for 6 weeks with x-rays done at 2 and 6 weeks then we removed the cast ourselves. He was happy with the new arm positioning and it still looks pretty good. He broke his radius on his BPI arm a week after taking off the cast, so that hindered his therapy. The plate stays in his arm forever, the incision is about 2 inches long and didn't heal as "pretty" as all of his other surgeries, we will most likely get a scar revision on that one. The cast was a full arm cast, all the way up to the armpit. There were just the usual restrictions after removing the cast. He had forearm osteotomy done last week and we are anxious to see the results from that one. He had a pronation contracture and so the ortho cut the radius and ulna, rotated them 30 degrees and put in pins, which will be removed in about 6 months.

I hope this was helpful. Overall, we were pretty happy with the results, his internal rotation seems to still be less, although it was hard to tell with the forearm being so pronated. I can't remember what the measurements were prior to surgery, so I can't tell you the exact improvement, but there was.

scriby95@verizon.net

[Josh'smom]

I just wanted to add something I found when I was researching this surgery for my son. I had two drs suggest the surgery for my son and both did it differently. What I mean is one casted after the surgery the other did not (arm was in a sling). One left the plate and screws in and the other went back in and took them out after 6 months(therefore another surgery) ?!?!. I was given names of people who had the surgery by one drs and decided to give a few a call. One women told me she had to have the surgery redone after about 5 years and didn't realize this when she originally had it done and said to me--to be honest If I could go back I don't think I would have done the surgery!! I was so shocked and surprised I choose NOT to have the surgery on my son at that time and still have not. THIS IS my experience and just wanted to share with everyone. This does not mean if I feel comfortable and know the surgery will help my son that I wouldn't choose to do it in the future. I would love to see the results of your survey. Hope you post them.

[Brenda333]

Here is a link that might help.

http://www.injurednewborn.com/gehring.html

[richinma2005]

This is kind of a review of additional research:

http://www.orthojournalhms.org/volume2/ ... cles13.htm

Secondary Reconstruction of the Shoulder

Children with chronic upper trunk plexopathy often develop an internal rotation contracture associated with external rotation weakness of the shoulder. The etiology is persistent muscle imbalance due to incomplete recovery from the infantile neural injury. It has been my impression that any persistent muscle imbalance in a growing child should also lead to bone and joint deformity. In conjunction with Dr. Diego Jaramillo of the Department of Radiology at Children's Hospital, we have developed a radiologic protocol to assess the glenohumeral joint by MRI and CT scans in children with chronic plexopathy. Children less than age five years of age had a MRI scan and children older than five years of age underwent CT scan. It was felt that this would give the most reliable structural information about the developing glenoid. This decision was based on a previous study of CT and MRI scans obtained for the evaluation of lung and mediastinal tumors and metastasis in children from the Children's Hospital and the Dana Farber Cancer Institute. That initial study, performed with Dr. Craig Mintzer during his orthopaedic residency at Harvard, defined normal glenoid version values according to age. (17) As a part of a long-standing research protocol, all children under consideration for reconstructive shoulder surgery obtain a preoperative CT or MRI scan to assess glenoid version, the degree of glenohumeral subluxation, and the extent of glenohumeral deformity as compared to the unaffected side.

Analysis of the initial radiographic data was published in the Journal of Bone and Joint Surgery in 1998 with Drs. Jaramillo and Garth Smith, a former Harvard hand surgery fellow, in an article entitled “Glenohumeral deformity secondary to brachial plexus birth palsy.” (18) The degree of glenohumeral deformity was progressive with age. The type of progressive deformity was reproducible and therefore, classifiable. Deformity progressed from type I (normal) to type V. A type II deformity was defined as increased glenoid retroversion by >5 degrees; type III as increased glenoid retroversion and posterior glenohumeral subluxation; type IV as the development of a false glenoid from progressive glenohumeral dislocation; and type V as the development of a deformed humeral head with flattening. Type VI and VII described special cases of infantile dislocation and proximal humeral growth arrest, respectively. The classification of deformity for a particular child with an internal rotation contracture and external rotation weakness was used to determine the appropriate procedure for the child. Children with types I-III were considered candidates for latissimus dorsi/teres major tendon transfer to the rotator cuff insertion at the greater tuberosity. Children with type V defor-mity were treated with a humeral external rotational osteotomy. Patients with a type IV deformity were treated with either a tendon transfer or an osteotomy depending on their age and degree of glenoid deformity. Younger patients, with glenoids that had the capacity to remodel, underwent tendon transfer. Humeral derotational osteotomies were performed in older patients with marked type IV deformity.

Thirty-six children treated with either a tendon transfer or humeral derotational osteotomy for internal rotation contracture and external rotation weakness were reevaluated at minimum two-year follow-up to determine the results of surgical intervention. This data was published in Clinical Orthopaedics and Related Research in a 1999 article entitled “Shoulder reconstruction in patients with chronic brachial plexus birth palsy.” (19) This study was co-authored with Dr. Allan Peljovich, a former Harvard hand surgery fellow. The study demonstrated that both tendon transfer and humeral derotational osteotomy significantly improved function in these children. By comparing pre-operative and post-operative Mallet scores, both operations improved function and external rotation. Shoulder reconstruction is thus strongly advocated for older children with impairment.

It is interesting to speculate on whether rebalancing the muscle forces early can prevent progressive deformity of the glenohumeral joint. In addition, the potential for glenohumeral joint remodeling is unclear. Patients with tendon transfers performed early in life are currently being followed with serial MRI and CT scans to assess the remodeling or progression of deformity. Early analysis suggests that the deformity does not progress and that the glenohumeral joint has the ability to remodel with surgical rebalancing of the muscle forces about the joint.

[admin]

My son had it done August 2005. He was 2 yrs 4 months old.He has severe internal rotation due to a muscle imbalance. So far the posistioning is great his DR said if we see a pull back that he would need some muscle work. To keep an eye on it. But to him he thought that the osteotomy itself would be fine.
His doctor said to leave the plate in and never remove it. After taking the cast off that arm was a little sensative. But now nothing slows him down. And he doesn't complain with pain anymore. Brayden was in a cast for six weeks. His cast was all of hia abdomen and his right arm up in the air. After the cast was removed he was up set and we gave him a snack he immediately used his right arm to feed himself. Hand to mouth 9never happened before that. He can also reach above his head not and supinate past neutral. He did therapy for 5 1/2 months and then his doctor didn't seee the need for it anymore. But his therapist goes to our church and I ask her questions all the time. She has assured me that he is doing great. Better thatn any other child she has seen. He had to go a little easy for about 2 months. Just gentle therapy and play and then after that noraml therpy and paly was fine. We start T-ball Thursday. He can actually throw a ball now and hit a ball using both arms. YEA!! Brayden was very upset right after surgery because he was still a little sleepy and it was new and he was confused but after we got home he was okay. I think it is very importatn to get kids back to their regular routine. After one day Brayden was running ang playing ang making me have a heart attack. He learned how to crawl under stuff with that bulky cast on. It was not a problem for him. As you can see I am very pleased with our decision and would do it again if I had to. I hope this helped some of you . I know how hard it is to get info on this surgery. Just a few months ago I too was researching. This is my experience with this surgery. Good Luck on making your decision. Feel free to email me with any other question.

Ashley, mom to Brayden ROBPI

[GAmom]

Sorry about the guest post. I was in a rush and didn't realize that I didnt' log in. Sorry it was me I admit it.

Ashley, mom to Brayden ROBPI

[admin]

Thank you for posting the link to that article. I spent some time trying to find the full text yesterday, and today - thanks to you - there it was.