**10. Bony procedures**

#### **10.1. Humeral rotational osteotomy**

Many late presenting cases may have developed glenohumeral dysplasia at the time of presentation. For such situations, humeral derotation osteotomy is one option to improve the function. Humeral derotation osteotomy does not improve the range of motion (ROM) of glenohumeral motion but reorients the arc of shoulder rotation into a more functional range which improves the function.

**11. Conclusion**

greater benefit.

**Author details**

\* and Dhiren Ganjwala2

1 Orthokids Hospital, Ahmedabad, India 2 Ganjwala Hospital, Ahmedabad, India

monwealth. 1973;**80**(1):60-62

May;**88**(3):F185-F189

2011 Sep;**44**(3):380-389

Joint Diseases. 2011;**69**(1):11-16

1985 Nov-Dec;**1**(6):367-369

Gynecology. 1997 Nov;**177**(5):1162-1164

sion 6-7

\*Address all correspondence to: maulinmshah@gmail.com

Reconstructive Surgery. 2015 Oct;**136**(4):765-779

Maulin Shah1

**References**

Results of BPBP have improved substantially by various advances that have taken place in the last four decades. We can achieve functional improvement in a majority of cases, but still most cases do not achieve a full functional recovery. Improvement in the surgical technique will lead to better outcome. On the other hand, efforts to prevent this condition will also yield

Current Concept in the Management of Brachial Plexus Birth Palsy

http://dx.doi.org/10.5772/intechopen.76109

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[6] Alfonso DT. Causes of neonatal brachial plexus palsy. Bulletin of the NYU Hospital for

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#### *10.1.1. Indications of humerus osteotomy*

Moderate-to-severe glenohumeral deformity (Waters Grades III–V) has restricted external rotation and abduction.

#### *10.1.2. Surgical technique*

Through a delto-pectoral approach, proximal humerus is exposed. Osteotomy is carried out just proximal to the insertion of deltoid. Distal fragment is rotated externally and is held firmly by the bone holding forceps. Before final fixation, it is confirmed that the hand can be easily placed to the mouth, occiput, perineum and midline in an effort to avoid overcorrection. This important step prevents overcorrection as well as under-correction.

#### *10.1.3. Results*

Kirkos and Papadopoulos [71] reported the results for 22 patients who underwent humerus derotation osteotomy. The authors have shown improvement in shoulder abduction of 27° and external rotation of 25° at a mean follow-up of 14 years (ranges from 2 to 31 years). An increase in forearm supination was also noted following improvement in shoulder external rotation.

Al-Qattan [72] also reported the results in a series of 15 children. At an average follow-up of 3 years, the patients demonstrated improvement in the mean modified Mallet score for handto-neck motion. It increased from 2.2 to 4 points.

Waters and Bae [73] used this operation in 28 patients. Osteotomy was fixed stably with internal fixation. All patients demonstrated improvements in shoulder function postoperatively, as evidenced by improved aggregate Mallet scores. The mean aggregate Mallet classification score improved from 13 points preoperatively to 18 points postoperatively.

#### **10.2. Glenoid anteversion osteotomy**

Hopyan and colleagues combined glenoid neck osteotomy with soft-tissue rebalancing surgeries [74]. The purpose of their study was to see whether glenoid reorientation converts a shoulder joint from one where tendon transfer and soft-tissue release cannot restore the active motion to the one where it can. They found improved Mallet scores for global external rotation and hand-to-neck movements. Waters schema was found improved from average of 4.3 preoperatively to 1.6 postoperatively. This novel technique was proposed as an alternative to humeral derotation osteotomy.
