VERTICAL SCAPULAR OSTEOTOMY FOR CORRECTION OF SPRENGEL’S DEFORMITY

Abstract

A vertical scapular osteotomy was first described by Wilkinson in 1980.

We report six children with a mean age of 9 years 6 months at operation (range 4–16). Mean abduction pre-operatively was 77 degrees (range 70–160 degrees). Cosmetically all were Cavendish grade three except one grade four. Five of the six had associated abnormalities of the cervical spine (three Klippel-Feil and one hemivertebra) and four had omovertebral bars. One boy had a full range of movement pre-op and had a cosmetic correction. One girl had a preceding Erbs palsy which had resolved completely prior to surgery.

Mean follow-up is five years (range 1–12 years). All patients have an excellent cosmetic result, four graded Cavendish one, two graded two, and one grade three. Mean abduction improved to 148 degrees and mean improvement was 77 degrees.

Sprengel’s deformity presents significant cosmetic and functional deficits. We have found the vertical scapular osteotomy as described by Wilkinson a simple and reliable procedure with predictably good results. With regards to the omovertebral bone, we concur that its presence has no influence on functional outcome. Cosmetically, when clothed, the result is excellent, with the shoulders level. Undressed, however, asymmetry is still obvious with a truncated shoulder girdle and persistence of some webbing or fullness in the base of the neck. This appears more marked when an omovertebral bone was present.

We conclude that a vertical scapular osteotomy is a reliable operation for improving shoulder girdle function, but that cosmetic objectives must be reliable.