Long-Term Results of Modified Green Method in Sprengel's Deformity

Abstract

Aim Congenital undescended scapula (Sprengel deformity) is a rare deformity that is reported in the literature mostly as small case series with short-or medium-term follow-up periods. Here, we aimed to present the long-term results of this deformity treated with modified Green procedure. Method The modified Green procedure was performed in 24 patients (28 shoulders) with Sprengel deformity. Clavicular osteotomy accompanied in all, and omovertebral bone excision in 13 shoulders. The mean age of the patients at the time of surgery was 4.5 years (range 1.5-17 years). Mean follow-up period was 11 years 4 months (4.3-17 years). Preoperative cosmetic appearance was noted as Cavendish III in 17 shoulders and as IV in 11 shoulders. In addition to the Cavendish scale, shoulder abduction, shoulder asymmetry, and scapular elevation and medialization were evaluated. ResultsThe decrease in scapular elevation and Cavendish scale, and the improvement in shoulder abduction and scapular medialization postoperatively were statistically significant (P \ 0.001). Cosmetic improvement of at least one Cavendish grade were attained in 88.9% of shoulders. One patient (unilateral) who was Cavendish grade IV preoperatively died in the early postoperative period from unrelated causes. Of the remaining 10 preoperatively grade IV shoulders, 2 remained at the same grade, 1 improved to grade III, and 7 shoulders to grade I. Of the 17 preoperatively grade III shoulders, 1 shoulder stayed the at same grade, 7 shoulders improved to II, and 9 shoulders to grade I. Postoperative winging in 2 shoulders and hypertrophic scarring in 6 shoulders were noted. Conclusion The modified Green procedure is a relatively safe and reliable method in the treatment of severe Sprengel deformity cases and provides highly constructive and aesthetic results in the long term.

Sprengel Deformity

“…[3][4][5] In the Sprengel deformity, there is restriction of the scapulothoracic motion, which restricts shoulder abduction. Methods: Between 2002 and 2009, 23 scapulae in 22 patients were treated.…”

Surgical treatment of Sprengel’s shoulder

“…7,20,21 There are few studies reporting the results of Green's procedure 4 or its modification. 9,14,22,23 The cosmetic results are satisfactory, with a mean lowering of the scapula by 1.5 vertebrae 14 and 1.9 vertebrae 22 in two series, respectively. In our series there was cosmetic improvement by at least one Cavendish grade in 54 shoulders (88.5%) ( Table I).…”

“…[2][3][4][5][6][7] reviewed 110 patients from different orthopaedic centres, and Gonen et al 9 and Ross and Cruess 10 described 28 and 77 cases, respectively -besides these, publications on the surgical treatment of Sprengel's shoulder are based on small studies, ranging from five to 22 patients. 11,12 The aim of this study was to present the largest series hitherto of patients with Sprengel's shoulder treated operatively at a single centre.…”

Rehabilitation Outcomes of Operated Sprengel Deformity (Congenital High Scapula): A Case Report

“…SD'ye eşlik eden anomaliler sıklıkla bulunur. SD tanısı klinik ve ön-arka akciğer grafisi ile konulsa da, bilgisayarlı tomografi ve manyetik rezonans görüntüleme bu hastalığa eşlik eden Klippel-Feil sendromu, konjenital skolyoz, böbrek hastalıkları, diastematomiyeli gibi anomalilerin tanısına ve tedavi planlanmasına yardımcı olur (10). SD'ye genellikle omovertebral kemik anormallikleri eşlik eder.…”

“…İki olguda ise postoperatif skapula kanatlanması bildirilmiştir. Bir diğer komplikasyon ise keloid oluşumu ve postoperatif skar gelişimidir (10,11). Burada sunulan olgu ise Woodward yöntemi ile opere edilmişti.…”