[Derotational osteotomy of humerus in the treatment of children with persistent brachial plexus palsy].

Patients with persistent brachial plexus palsy, advanced secondary deformity of gleno-humeral joint and rigid adduction and internal rotation contracture are candidates for external derotation osteotomy of the humerus. The aim of the study was to analyze the clinical results of patients treated with humeral derotational osteotomy. The analysis was performed on 9 patients in the average age of 12.5 years. Before surgery 4 of them had dislocation, 2 subluxation and 3 advanced deformity of gleno-humeral joint. After the operation active external rotation improved 46 degrees and passive 55 degrees. In all patients improvement of shoulder function of 5 points according to Mallet classification was noted. Active internal rotation decreased from 6 to 4 points according to our own classification, and passive internal rotation deteriorated from 6 to 5 points. Flexion and abduction in gleno-humeral joint as well as flexion contracture of the elbow has not changed significantly. The trumpet sign was present in any of our patients. The follow up ranged from 1 to 8 years. Our results confirms that external derotational osteotomy of the humerus significantly improves shoulder function in patients with persistent brachial plexus palsy. This is a valuable method of treatment in patients with advanced gleno-humeral dysplasia that are not candidates for soft tissue releases and muscle transfers.