Rotation osteotomy of the humerus for Erb's palsy in children with humeral head deformity.

The most common secondary deformity in older children with Erb's birth palsy is internal rotation contracture of the shoulder. The results of external rotation osteotomy of the humerus in a selected series of children with shoulder internal rotation contracture are reported. Fifteen consecutive patients with a mean age of 6.5 years were included. In all children the internal rotation contracture was associated with loss of the normal sphericity of the humeral head as assessed by preoperative magnetic resonance imaging. The humerus osteotomy was carried out just below the insertion of the deltoid muscle, and fixation was done with stainless steel plate and screws. The results were assessed with a modified Mallet score. Before surgery 12 children had a score of 2 and 3 children had a score of 3. At final follow-up evaluation (range, 1-5 years; average, 3 years), all 15 children had improved shoulder function and obtained a modified Mallet score of 4. An extra bonus of the osteotomy procedure was slight improvement of shoulder abduction and elbow extension. All children could dress, wash, perform self-cleaning, and feed themselves better and no longer needed help with these activities. This osteotomy for selected children is simple and safe and has a high satisfaction rate functionally and aesthetically.