United Brachial Plexus Network, Inc.

Seems like we have seen this topic alot here lately, but what exactly is the humeral osteotomy suppose to improve? What is the purpose of it? Peyton can lift his arm over his head, get behind his head, when he lays down he can put arm behind his head. Dr. Nath has suggested this for Peyton so I am just wondering how this may help Peyton. I am going to email Dr. Nath and ask him these same questions. Anyone who has had this done, how did it help your little one?

Just bringing this back to the top........

an osteotomy repositions the arm by repositioning the bone so that function can be increased - they actually cut the bone in half and set it(and put plates on it to hold it in the new position) so that it heals in an entirely new position.

can't say what specifically it can do for peyton but Dr. Nath will explain it fully- i'm sure that the repositioning would be different for each child depending upon the nature of the dysfunction

it's a surgery that's been around for those with bpi for a long time

sorry marnie - that's all I know about it...
maia has this coming up in her future, too.

good luck,
francine

Does anyone know if they cut the bone and it heals in a different position, is the child able to turn the hand to the neutral position or palm down?

The osteotomy actually causes loss of function because the humerus is being permanently placed in a position. It will give the shoulder joint more stability though. I personally have refused the surgery as i feel function is more important then stability. My son has much more movement because of my decision. You really need to be specific when asking Dr Nath or any other surgeon what function your child will use as i have come across other parents here who have been told by other surgeons that their child will lose function. Good luck in your decisions. All our childrens injuries are so different so it is very hard to compare.

Has anyone had the osteotomy and actually lost function?

Good point and interesting. I have been wondering myself and am being told by one doctor that my child has nothing to lose from another surgical procedure, but my common sense says NO major muscle altering procedure will not come with some price. I wonder why sometimes we aren't told that price? Is it that they feel the gains are so much more and take it upon themselves to not inform us of possible loses or is it more lack of following up our children over the years? The injuries are so different and that only seems to complicate all of it. I am glad your decision has seemed to work out in your child's best interest.

Here is a site where which children are suitable candidates for the osteotomy is discussed. The author is a renowned orthpedic surgeon who specialises in bpi. It's interesting to note he is collaborating in his efforts to find the best way forward with other bpi centers, including Dr Gilbert in Paris. Long but informative article. http://healthcare.partners.org/orthopae ... cles13.htm

Marnie - I think you have to be VERY specific about your questions... maybe this page will give you a brain jog to help you formulate your questions?
http://www.injurednewborn.com/maia/drquestions.html

For example...
Are there any movements that Peyton WON'T be able to do post osteo?
Are there any movements that Peyton WILL be able to do that he can't do now?
Will Peyton lose muscle strength? or will he gain muscle strength?
What happens to the joint once the osteo is performed? short term? long term?
Can the osteo fail? if so how?
Does it ever have to be redone at a later date?
Are the bones ever mal-positioned during the surgery as an error rather than repositioned and if this were to happen what would be done? (has this ever happened?)
Is there a secondary issue(s) that will form AFTER the osteo? What does the future hold..

I'm sure there are many more questions. I hope that others can come forward and help with the questions that they would have as well...

Just keep on questioning (like you are already doing) until you gut says yay or nay. And remember that each child is different, each injury is different- muscles are different (peyton already had a MQ so there are big differences between him and someone that didn't have it) and the procedure itself can be so different(angle at which the bone is set in).

Can you let us know what you find out so that we can learn from it?
-francine

These are great questions which I am writing down in case my child ever needs this surgery. I think the very difficult part is that some of us do ask many questions and seem to get VERY different answers among top and very experienced specialists. This is extrememly confusing, and to me points to huge need for research and scientific long-term studies with our children, as well as collaboration among BPI specialists, so that the best treatment for our children is not just based on a personal opinion, but on data that results in a treatment protocol and actual consistency between top docs. Going with a gut feeling is important and we always are talking about it here, but is it really enough to make such huge decisions??? especially when our gut is very vulnerable, wants the best for our children, has fear, hope, etc. We need more. Besides my gut felt that I made the right decision with my OB/GYN, so much for my gut. Sorry to go on and on. Us parents are just in a hard place.