United Brachial Plexus Network, Inc.

Paula,

I too think of it as "cosmetic", but lately I am starting to think differently. I asked Dr. Hoffer if he thought it was cosmetic, and he said he would never do anything "cosmetic" to any child. It is one surgery that never sat well with me. It just may be "our last resort".

Jody - mom to Alyssa (10) LOBPI

Thanks for posting that Kate and Francine very interesting info.

Paula - remember I told you about that young lady who had an osteotomy and she wrote to me to tell me about her "new arm". Well I saw her on Friday night and her osteotomy results just blew me away. She had pre-range movement very similar to Maia - that is how we met actually (at the PA picnic). [And the interesting thing about her is that Maia had an appointment for a Hum. Ost. on December 14th with Dr. Davino and after that picnic I cancelled that appointment and this young woman ended up taking that appointment slot! How uncanny is that.]

I took a very short video of her movement and she has given me permission to post it.

Here's what she wrote to me:

"After seeing Maia, I definitely agree that the osteotomy would help. Unfortunately she is still growing. Dr. Davino told me that sometimes they have to do the osteotomy more than once for children. I would highly suggest it to anyone. And don't believe anyone who says that it is cosmetic, because this surgery has helped more with more motion than I could have ever imagined. If anything, it is the opposite of cosmetic because now I have a nice scar on the front of my arm, haha."

Here's the video of the young woman and following it is Maia's range video - they were very similar.

http://www.youtube.com/watch?v=Lup0gO8B6fs

http://www.youtube.com/watch?v=pw8SMTbPJ1E

here's my email: franlitz@gmail.com

I want to add that I do believe that where you fracture the bone and how you rotate the bone will make all the difference as to whether or not it will be a "functional" result HO or a cosmetic result HO. Different doctors fracture the bone in different places...and then they rotate differently as well.

Holy cow, Francine! What an incredible result. Maybe I will have to rethink this surgery for Joshua, as well. Most of my 3.5 years with him have been aimed at avoiding it...

Kate

Yes I know... me too... there's no denying what it has done for this young woman. But as you know... for every success there is a failure.... this is just one person. I've seen this coin flip both ways.

As much as I want to say "yeah - let's do it" I think we need to look further into why an HO might fail a child. What issues are present in the child and what is done in the technique that makes the procedure fail (or rather not provide a positive change).

Somebody would have to write a program that would compare before and after measurements - with fracture site and rotational degrees to come up with that answer...

Wow Francine, thanks for sharing the video!!! Is that her arm popping when she moves it?

DR. Nath also once suggested redoing Peyton's triangle tilt. He wanted to do an added acr and clavicle bone graft. We are waiting at this point to do any surgeries. Peyton does not want anymore surgeries. That may change in the future, but it's so frustrating to go through a surgery and then lose everything. Here are some photos of 3 months post triangle tilt and then 2 years 3 months post triangle tilt.

http://inlinethumb38.webshots.com/24293 ... 600Q85.jpg

http://inlinethumb34.webshots.com/25185 ... 600Q85.jpg





Francine, do you have photos or video of this girl before her osteotomy?

I have never thought of the HO as cosmetic. Years ago a friend's daughter did it and it made a HUGE difference in her life. We are told that the HO is a "last resort", yet osteotomy has been a part of orthopedic surgery forever.

I absolutely agree with Francine that you need to get numerous opinions because different docs see the HO in different ways and do it differently. Plus, you need to make clear what functions CAN'T be "lost" to the HO.

I wish Juliana's mq had been done differently...the doctor at that time told us that he was "saving her from the osteotomy" so he did a full cut mq. Knowing what I know now, I would have jumped down his throat for that.

Where is the harm in investigating?? There is so much to learn.

claudia

she promised to get me "before" stuff...I'll post it as soon as I have it. I noticed the clicking too but I don't know if that was her or me....I emailed her.

Francine,

Do you know if this girl had glenohumeral malformation, and/or was subluxation and/or dislocated? Also, any idea where her humerus was cut and rotated (ie above or below deltoid insertion/pec etc)?

I absolutely agree that only one person is not sufficient to make any sort of judgement on. I think my response was more along the lines of I didn't think an osteotomy *could* provide that much function ever. Very interesting!

Kate