Green's surgical procedure in Sprengel's deformity: cosmetic and functional results.

INTRODUCTION: Multiple surgical options are available in the treatment of severe Sprengel's deformities and vary according to the selected muscle disinsertion site. We report here the functional and cosmetic results of the Green's operative technique.
MATERIAL AND METHODS: We retrospectively reviewed cases of congenital elevation of the scapula operated on, between 1999 and 2007, at Saint-Denis Regional Hospital Center. Clinical and radiographic examinations along with parents questioning were performed.
RESULTS: This study included eight children with a mean follow-up of 4.5 years. Improvement occurred in all cases: the appearance was improved by one grade in three children and two grades in three other children, according to the Rigault's classification system. Cosmetically, all families were satisfied with the final result of the treatment. A case of complete brachial plexus palsy (BPP) that resolved spontaneously within 7 months was observed. DISCUSSION: Sprengel's deformity is an unusual skeletal abnormality. The Green's operative technique allows both lowering and rotation of the scapula. Muscle attachment is distally, rather than proximally, modified which provides a better biomechanical effect: muscles are reattached higher than the acromiothoracic junction's rotation center. The Green's scapuloplasty has been rarely reported in literature, whereas the Woodward procedure remains the reference standard. However, both techniques report similar results. Our choice was based on a better impression in terms of operative approach and improved muscle levers' distance adjustment to the fulcrum. Finally, resection of the superomedial portion of the scapula which is fixed to the rib cage into a pocket of the latissimus dorsi seems to provide a more efficient correction. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic study. 2009 Elsevier Masson SAS. All rights reserved.