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A Novel Modification of Woodward Procedure for Correction of Sprengel Deformity by Application of Anchoring Sutures

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Abstract

Purpose

To report the functional and cosmetic results of cases with Sprengel deformity (SD) who underwent a novel technical modification in Woodward procedure for severe SD comprising of lowering of the scapula followed by stabilization of scapula with application of anchoring sutures.

Materials and methods

Twenty-three children were operated at a mean age of 6.6 ± 2.5 years (range 3.4–11 years) and followed up for a mean period of 5.51 ± 1.98 years.

Results

The mean Cavendish score of the patients before procedure of 3.2 ± 0.45 was reduced to 1.7 ± 0.56 (p < 0.001) after the surgery. All patients improved in global shoulder abduction. The mean preoperative abduction of 97° ± 15.2° increased to a mean of 149° ± 14.1° post-operatively (p < 0.001). Significant improvement was also observed in mean Rigault grades after surgical intervention using anchoring suture modification of Woodward procedure. The mean Rigault grade of 2.7 ± 0.47 prior to surgery was reduced to 1.3 ± 0.47 (p < 0.001) at final evaluation. Age of the patients negatively correlated with the functional outcome (r =  – 0.48; p < 0.02). The presence of an omovertebral bar or associated congenital anomalies did not affect the functional outcome.

Conclusion

The modification of Woodward procedure for correction of SD by application of anchoring sutures was a reliable method for correction of SD particularly at younger age. The procedure was associated with significant improvement in shoulder abduction, cosmetic appearance and radiological grades over 5 year follow-up.

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References

  1. Eulenberg, M. (1863). Casuistsche Mittheilungen aus dem Gebiete der Orthopädie. Langenbecks Arch KlinChir 4, 301–311.

  2. Sprengel, R.D. (1891). Die angeborenen Vershiebung des Schulterblattes nach oben. Langenbeks Arch KlinChir 42,:5456.

  3. Dilli, A., Ayaz, U. Y., Damar, C., Ersan, O., & Hekimoglu, B. (2011). Sprengel deformity: magnetic resonance imaging findings in two pediatric cases. Journal Clinical Imaging Science, 1, 17–20.

    Google Scholar 

  4. Samilson, R. L. (1980). Congenital and developmental anomalies of the shoulder girdle. Orthopedic Clinics of North America, 11, 219–231.

    Article  CAS  Google Scholar 

  5. Mears, D. C. (2001). Partial resection of the scapula and a release of the longhead of triceps for the management of Sprengel’s deformity. Journal of Pediatric Orthopedics, 21, 242–245.

    CAS  PubMed  Google Scholar 

  6. McMurtry, I., Bennet, G. C., & Bradish, C. (2005 Jul). Osteotomy for congenital elevation of the scapula (Sprenel’s deformity). Journal of Bone and Joint Surgery. British Volume, 87(7), 986–989.

    Article  CAS  Google Scholar 

  7. Andrault, G., Salmeron, F., & Laville, J. M. (2009). Green’s surgical procedure in Sprengel’s deformity:cosmetic and functional results. Orthopaedics and Traumatology Surgical and Research, 95, 330–335.

    Article  CAS  Google Scholar 

  8. Aydinli, U., Ozturk, C., Akesen, B., & Ozer, O. (2005). Surgical treatment of Sprengel’s deformity: a modified Green procedure. Acta Orthopaedica Belgica, 71, 264–268.

    PubMed  Google Scholar 

  9. Schrock, R. D. (2008). Congenital elevation of the scapula: Robert D. Schrock MD (1884-1960). The 9th president of the AAOS 1940. Clinical Orthopaedics and Related Research, 466, 74–80.

  10. Borges, J. L., Shah, A., Torres, B. C., & Bowen, J. R. (1996). Modified Woodward procedure for Sprengel deformity of the shoulder: long-term results. Journal of Pediatric Orthopaedics, 16, 508–513.

    Article  CAS  Google Scholar 

  11. Khairouni, A., Bensahel, H., Csukonyi, Z., Desgrippes, Y., & Pennecot, G. F. (2002). Congenital high scapula. Journal of Pediatric Orthopedics Part B, 11, 85–88.

    PubMed  Google Scholar 

  12. Woodward, J. W. (1961). Congenital elevation of the scapula: Correction by release and transplantation of muscle origins. Journal of Bone and Joint Surgery American Volume, 43, 219–228.

    Article  Google Scholar 

  13. Cavendish, M. E. (1972). Congenital elevation of the scapula. Journal of Bone and Joint Surgery British Volume, 54, 395–408.

    Article  CAS  Google Scholar 

  14. Rigault, P., Puoliquen, J. C., Guyonvarch, G., & Zujovic, J. (1976). Congenital elevation of the scapula in childhood. Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 62, 5–26.

    CAS  PubMed  Google Scholar 

  15. Ahmad, A. (2010). Surgical correction of severe Sprengel deformity to allow greater postoperative range of shoulder abduction. Journal of Pediatric Orthopedics, 30(6), 575–581.

    Article  Google Scholar 

  16. Green, W. T. (1957). The surgical correction of congenital elevation of the scapula (Sprengel’sdeformity). Journal of Bone and Joint Surgery American Volume, 39, 149–151.

    Google Scholar 

  17. Wilkinson, J. A., & Campbell, D. (1980). Scapula osteotomy for Sprengel’s shoulder. Journal of Bone and Joint Surgery British Volume, 62, 486–490.

    Article  Google Scholar 

  18. Crha, B. (2001). Surgical treatment of Sprengel’s deformity of the scapula. SCRIPTA MEDICA (BRNO), 74, 245–254.

    Google Scholar 

  19. Grogan, D. P., Stanley, E. A., & Bobechko, W. P. (1983). The congenital undescended scapula. Surgical correction by the Woodward procedure. The Journal of Bone and Joint Surgery British Volume, 65, 598–605.

    Article  CAS  Google Scholar 

  20. Jeannopoulos, C. L. (1952). Congenital elevation of the scapula. Journal Bone Joint Surgery. America 34, 883–892.

  21. Jeannopoulos, C. L. (1961). Observations on congenital elevation of the scapula. Clinical Orthopaedics and Related Research, 20, 132–137.

    CAS  Google Scholar 

  22. Ross, D. M., & Cruess, R. L. (1977). The surgical correction of congenital elevation of the scapula. A review of seventy-seven cases. Clinical Orthopaedics, 125, 17–23.

    Google Scholar 

  23. Carson, W. G., Lowell, W. W., & Whiteside, T. E. (1981). Congenital elevation of the scapula Surgical correction by the Woodward procedure. Journal of Bone Joint Surgery America, 63A, 1199–1207.

    Article  Google Scholar 

  24. Walstra, F. E., Alta, T. D., van der Eijken, J. W., Willems, W. J., & Ham, S. J. (2013). Long-term follow-up of Sprengel’s deformity treated with the Woodward procedure. Journal of Shoulder and Elbow Surgery, 22, 752–759.

    Article  Google Scholar 

  25. Jindal, N., & Gupta, P. (2012). Sprengel’s shoulder treated by the Woodward procedure: analysis of factors affecting functional and cosmetic outcome. Journal of Children's Orthopaedics, 6, 291–296.

    Article  Google Scholar 

  26. Klisic, P., Filipovic, M., Uzelac, O., & Milinkovic, Z. (1981). Relocation of congenitally elevated scapula. Journal of Pediatric Orthopedics, 1, 43–45.

    Article  CAS  Google Scholar 

  27. Robinson, R. A., Braun, R. M., Mack, P., & Zadek, R. (1967). The surgical importance of theclavicular component of Sprengel's deformity. Journal of Bone and Joint Surgery. American Volume, 49, 1481.

    Google Scholar 

  28. Wada, A., Nakamura, T., Fujii, T., Takamura, K., Yanagida, H., Yamaguchi, T., et al. (2014). Sprengel Deformity: Morphometric Assessment andSurgical Treatment by the Modified Green Procedure. Pediatric Orthopaedics, 34, 55–62.

    Article  Google Scholar 

  29. Gonen, E., Simsek, U., Solak, S., Bektaser, B., Ates, Y., & Aydin, E. (2010). Long-term results of modified Green method in Sprengel’s deformity. Journal of Children's Orthopaedics, 4, 309–314.

    Article  Google Scholar 

  30. Dendane, A. M., Amrani, A., El Medhi, T., El Alami, Z., Gourinda, H., & Miri, A. (2004). Congenital elevation of the scapula. La Tunisie Medicale, 82(11), 1032–1037.

    PubMed  Google Scholar 

  31. Greitemann, B., Rondhuis, J. J., & Karbowski, A. (1993). Treatment of congenital elevation of the scapula: 10 (2–18) year follow-up of 37 cases of Sprengel’s deformity. Acta Orthopaedica Scandinavica, 64(3), 365–368.

    Article  CAS  Google Scholar 

  32. Zoppi, A. F., Ferreira, A. A. F., Robazzi, P. S. M., Ferreira, A. A. N., Benegas, E., & Costa, A. J. F. (1995). Deformidade de Sprengel-Revisão de 15 casosoperados. Rev Bras Ortop., 30(9), 665–668.

    Google Scholar 

  33. Van Heat, A. E. (1996). Congenital disorders of the hand and upper extremity. Pediatric Clinics of North America, 43–5, 1119–1121.

    Google Scholar 

  34. Farsetti, P., Weinstein, S. L., Caterini, R., De Maio, F., & Ippolito, E. (2003). Sprengel’s deformity: long-term follow-up study of 22 cases. Journal of Pediatric Orthopedics. Part B, 12(3), 202–210.

    PubMed  Google Scholar 

  35. da Silva Reginaldo, S., de Macedo, R. R., de Andrade Amaral, R., Cardoso, A. L., Araújo, HR4., Daher, S. (2009). Sprengel's deformity: surgical correction by a modified green procedure. Rev Bras Ortop 44(3), 208–213.

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Acknowledgements

The authors are grateful to the Deanship of Scientific Research, King Saud University, Saudi Arabia, for funding this work through the Voice Deanship Research Chair. I would like to express my deep gratitude to Professor Zahid Shakoor department of immunology for his enthusiastic encouragement and useful critiques of this research work.

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Authors and Affiliations

  1. Department of Orthopaedics (49), College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Abdulmonem M. Alsiddiky, Khalid A. Bakarman & Fahad S. Alhuzaimi

  2. Department of Orthopaedics, FCPS, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Zulqurnain Rafiq

  3. Department of Orthopaedics, King Khalid University Hospital Riyadh, Riyadh, Saudi Arabia

    Muhammad Asif

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  1. Abdulmonem M. Alsiddiky
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  2. Zulqurnain Rafiq
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Correspondence to Zulqurnain Rafiq.

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Alsiddiky, A.M., Rafiq, Z., Bakarman, K.A. et al. A Novel Modification of Woodward Procedure for Correction of Sprengel Deformity by Application of Anchoring Sutures. JOIO 55 (Suppl 1), 189–198 (2021). https://doi.org/10.1007/s43465-020-00187-3

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