Functional Outcome Following Proximal Humeral Derotation Osteotomy in Erb’s Palsy Falah Kadhim Hasan FIBMS, Ali Eskander Dagher MRCS

Keywords: Erb’s palsy, Proximal humeral osteotomy, Mallet grading system


Background: Obstetric brachial plexus palsy is an injury to the nerves of the upper
extremity of the newborn that happens during labor. Erb’s palsy (C5, 6) is the most common
type of obstetric brachial plexus palsy. Most of the infants with Erb’s palsy will show
spontaneous full recovery, however 20 -30 % will have residual neurological defects, some
of them will have residual weakness of shoulder’s external rotation, which will result in an
internal rotation deformity of the affected shoulder in these children. If this internal rotation
deformity is not repaired, it may progress to posterior dislocation of the shoulder joint with
bony deformity of the glenoid.
Objective: To present functional outcome and results from patients with Erb’s palsy who
underwent external rotational humeral osteotomy.
Methods: Proximal humeral osteotomy was done for fourteen patients to correct deformity
during age ranging from 13 to 20 years. Preoperative; early postoperative and late
postoperative functional assessments were compared using mallet-grading system.
Results: Preoperatively out of 14 patients 10 (seven females, 3 males) were grade 2 mallet
grading system range (8-12 points), four were grade 3 range (12-18 points) mallet grading
system (2 males, 2 females). One month follow up post operatively patients with grading
two (10 patients) mallet system preoperatively seven patients of them became grade 4
(70%). After one year, three patients became grade 3 (15 points) (30%). Two years follow
up, 13 patients out of 14 were in grade 4 (20 points), one patient with grade 3 (15 points).
Eight of the 14 patients were followed up 3 years postoperatively all of them had grade 4 in
comparison between pre-operative function of the shoulder joint and 2 years post proximal
humeral osteotomy, 9 out of 14 (64%) patients upgrade from grade 2 into grade 4, and 5
out of 14 (36%) patients upgrade from grade 3 to grade 4.
Conclusions: Proximal humeral osteotomy gives good function of shoulder movement and
patient satisfaction. The gaining of functional improvement was clear in early and late time
following rotational humeral osteotomy