Older children often develop substantial glenohumeral deformity secondary to an internal rotation about the shoulder. The standard approach to correct limb alignment is a rotational osteotomy of the humerus placing the arm into more external rotation. The traditional approach has been via a deltopectoral approach. This article decribes a medial approach in 23 children.
The internervous plain is between the medial and ulnar nerves to expose the humerus. The osteotomy is transverse in fashion and fixation is accomplished with a plate and screw construct. The results indicate that the correction averaged 43 degrees. All patients healed their incisions without complications. There was one patient that fractured through the plate two times after falling. This particular patient had residual global brachial plexus palsy with decreased sensibility and awareness of the affected limb.
This paper highlights a different approach to humeral osteotomy. Whether the bone is corrected through the anterior deltopectoral approach or medial incision is controversial. The medial incision is better hidden and facilitates external rotation during osteotomy. However, both approaches seem lead to improvement in function and activities of the daily living, as assessed by the results. The surgeon should consider the medial approach, especially when concerns of cosmesis and position are paramount.