Sprengel's Deformity: Surgical Correction by a Modified Green Procedure

Abstract

Objective: To evaluate the cosmetic and functional results of patients submitted to surgical correction of Congenital High Scapula (Sprengel's Deformity) using modified Green's Procedure, as well as patients' satisfaction and complications. Methods: Nine patients submitted to surgical treatment from September 1993 to April 2008 have been assessed. The modification from original technique was: subperiosteal muscle detachment, resection of superomedial scapular portion and fixation of medial portion of scapular spine to contralateral posterior iliac crest instead of skeletal traction, with subcutaneous wire. The mean age was 7 years and 3 months. The mean follow-up time was 3 years and 7 months. Results: The mean improvement in forward elevation was 39o (range 0 to 80o). According to the Cavendish Classification, cosmetic improvement of two degrees was achieved in eight cases, and three degrees in one. All patients were satisfied with results. Conclusions: Surgical correction of Sprengel's Deformity by a modified Green's procedure with contralateral posterior iliac crest fixation instead of skeletal traction, showed both cosmetic and functional improvements; all patients and/or family members were satisfied with the results, and the complications associated to the surgical technique did not interfere on end results.

Surgical Treatment of Sprengel’s Deformity: A Systematic Review and Meta-Analysis

“…Most studies reported the patients’ sex, except three [ 34 , 43 , 57 ], and the affected side, except eight [ 21 , 23 , 43 , 47 , 50 , 54 , 57 , 59 ]. In the preoperative evaluation, 28 studies classified patients according to the Cavendish clinical scoring system [ 2 , 9 , 14 , 16 , 17 , 19 , 20 , 21 , 23 , 33 , 35 , 36 , 37 , 38 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 52 , 53 , 55 , 58 , 59 , 60 ] and 15 studies [ 14 , 15 , 16 , 17 , 19 , 21 , 32 , 36 , 41 , 45 , 48 , 53 , 57 ,…”

“…Twenty-three studies (441 patients) reported the grade of deformity, according to the Cavendish classification [ 9 , 14 , 16 , 17 , 19 , 20 , 21 , 23 , 35 , 36 , 37 , 41 , 42 , 44 , 45 , 46 , 48 , 52 , 53 , 55 , 58 , 59 , 60 ]. Ninety-seven patients (22%) were grade 4, 283 patients (64.2%) were grade 3, 51 patients (11.5%) were grade 2 and 10 patients (2.3%) were grade 1.…”

“…The Putti–Schrock procedure was reported only by Farsetti [ 32 ] and Sulamaa [ 13 ] in nine cases. The original and modified Green procedure was reported in 14 papers [ 14 , 15 , 23 , 34 , 35 , 37 , 39 , 40 , 44 , 45 , 47 , 48 , 51 , 53 ], accounting for 280 patients; Woodward’s procedure (or modified techniques) was performed in 18 studies [ 2 , 9 , 16 , 17 , 23 , 32 , 33 , 42 , 43 , 46 , 49 , 50 , 54 , 55 , 56 , 57 , 58 , 60 ], accounting for 234 patients. Bhasker [ 41 ], Masquijo [ 19 ] and Mears [ 18 ] treated 29 patients overall with Mears’s technique.…”

“…Twenty-three studies (383 patients) reported the postoperative Cavendish grade [ 2 , 9 , 14 , 16 , 17 , 19 , 20 , 21 , 33 , 35 , 36 , 37 , 41 , 42 , 44 , 45 , 46 , 48 , 52 , 55 , 58 , 59 , 60 ]. Of them, 16 studies (236 patients) [ 14 , 17 , 19 , 20 , 21 , 35 , 36 , 37 , 41 , 44 , 46 , 52 , 55 , 58 , 59 , 60 ] reported preoperative and postoperative raw data. Fourteen studies (219 patients) reported the postoperative Rigault classification [ 14 , 15 , 16 , 17 , 19 , 21 , 32 , 36 , 41 , 45 , 48 , 57 , 58 …”

“…We counted 18 major complications (2.5%), classified as grade 3 according to the CDS system. Among them, we noted a seroma that required surgical drainage [ 35 ]; a granuloma of the suture [ 16 ]; hardware removal due to breakage in two patients [ 44 ]; deep infection in two patients [ 51 ]; heterotopic ossifications causing limitations and pain in three patients [ 18 , 19 , 35 ]. Naik [ 53 ] described two patients with skin necrosis, one of whom needed a second intervention to resolve the problem; furthermore, he reported brachial plexus palsy and the loss of radial pulsation in one patient, requiring clavicle osteotomy, with recovery after 4 weeks.…”