Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

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.

Results

The 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Beaty JH (2003) Congenital anomalies of trunk and upper extremity. In: Canale ST (ed) Campbell’s operative orthopaedics, 10th edn. CV Mosby, St. Louis, pp 1125–1140

    Google Scholar 

  2. Schrock RD (1926) Congenital elevation of the scapula. J Bone Joint Surg Am 8:207–215 (reprinted in: Brand RA (2008) The Classic. Congenital elevation of the scapula: Robert D. Schrock MD (1884–1960). The 9th president of the AAOS 1940. Clin Orthop Relat Res 466(1):74–80. doi:10.1007/s11999-007-0025-2)

    Google Scholar 

  3. Cavendish ME (1972) Congenital elevation of the scapula. J Bone Joint Surg 54B(3):395–408

    Google Scholar 

  4. Greitemann B, Rondhuis JJ, Karbowski A (1993) Treatment of congenital elevation of the scapula. 10 (2–18) year follow-up of 37 cases of Sprengel’s deformity. Acta Orthop Scan 64(3):365–368. doi:10.3109/17453679308993646

    Article  CAS  Google Scholar 

  5. Aydinli U, Ozturk C, Akesen B, Ozer O (2005) Surgical treatment of Sprengel’s deformity: a modified Green procedure. Acta Orthop Belg 71(3):264–268

    Google Scholar 

  6. Cho TJ, Choi IH, Chung CY, Hwang JK (2000) The Sprengel deformity. Morphometric analysis using 3D-CT and its clinical relevance. J Bone Joint Surg Br 82(5):711–718. doi:0301-620X/00/510389

    Article  CAS  Google Scholar 

  7. Farsetti P, Weinstein SL, Caterini R, De Maio F, Ippolito E (2003) Sprengel’s deformity: long-term follow-up study of 22 cases. J Pediatr Orthop B 12(3):202–210. doi:10.1097/01.bpb.0000049568.52224.1e

    Google Scholar 

  8. Mears DC (2001) Partial resection of the scapula and a release of the long head of triceps for the management of Sprengel’s deformity. J Pediatr Orthop 21(2):242–245

    CAS  Google Scholar 

  9. Hamner DL, Hall JE (1995) Sprengel’s deformity associated with multidirectional shoulder instability. J Pediatr Orthop 15(5):641–643

    Article  CAS  Google Scholar 

  10. Leibovic SJ, Erlich MG, Zaleske DJ (1990) Sprengel deformity. J Bone Joint Surg 72A:192–197

    Google Scholar 

  11. Tachdjian MO (1990) Congenital deformities. In: Tachdjian MO (ed) Tachdjian’s pediatric orthopedics, 2nd edn. Saunders, Philadelphia, pp 136–168

    Google Scholar 

  12. Green WT (1957) The surgical correction of congenital elevation of the scapula (Sprengel’s deformity). J Bone Joint Surg 39A:1439–1448

    Google Scholar 

  13. Robinson R, Braun R, Mack P, Zadek R (1967) The surgical importance of the clavicular component of Sprengel’s deformity. J Bone Joint Surg Am 49-A:1481

    Google Scholar 

  14. Woodward JW (1961) Congenital elevation of the scapula. Correction by release and transplantation of muscle origins. A preliminary report. J Bone Joint Surg 43A:219–228

    Google Scholar 

  15. Bellemans M, Lamoureux J (1999) Results of surgical treatment of Sprengel deformity by a modified Green’s procedure. J Pediatr Orthop B 8(3):194–196

    Article  CAS  Google Scholar 

  16. Carson WG, Lowell WW, Whiteside TE (1981) Congenital elevation of the scapula. Surgical correction by the Woodward procedure. J Bone Joint Surg 63A:1199–1207

    Google Scholar 

  17. Ross MD, Cruess RL (1977) The surgical correction of congenital elevation of the scapula. Clin Orthop 125:17–23

    Google Scholar 

  18. Masquijo JJ, Bassini O, Paganini F, Goyeneche R, Miscione H (2009) Congenital elevation of the scapula: surgical treatment with Mears technique. J Pediatr Orthop 29(3):269–274

    Article  Google Scholar 

  19. Andrault G, Salmeron F, Laville JM (2009) Green’s surgical procedure in Sprengel’s deformity: cosmetic and functional results. Orthop Traumatol Surg Res 95(5):330–335. doi:10.1016/j.otsr.2009.04.015

    Article  CAS  Google Scholar 

  20. Borges JL, Shah A, Torres BC, Bowen JR (1996) Modified Woodward procedure for Sprengel deformity of the shoulder: long-term results. J Pediatr Orthop 16(4):508–513

    Article  CAS  Google Scholar 

  21. Ciaudo O, Bensahel H, Desgrippes Y, Csukonyi Z (1984) Therapeutic remarks on the congenital elevation of the scapula. Apropos of 16 cases (in French). Chir Pediatr 25(1):58–63

    CAS  Google Scholar 

  22. Doita M, Iio H, Mizuno K (2000) Surgical management of Sprengel’s deformity in adults. Clin Orthop 371:119–124

    Article  Google Scholar 

  23. Grogan DP, Stanley EA, Bobechko WP (1983) Congenital undescended scapula. Surgical correction by the Woodward procedure. J Bone Joint Surg 65B(5):598–605

    Google Scholar 

  24. Khairouni A, Bensahel H, Csukonyi Z, Desgrippes Y, Pennecot GF (2002) Congenital high scapula. J Pediatr Orthop B 11(1):85–88

    Google Scholar 

  25. Zhang ZM, Zhang J, Lu ML, Cao GL, Dai LY (2007) Partial scapulectomy for congenital elevation of the scapula. Clin Orthop Relat Res 457:171–175. doi:10.1097/BLO.0b013e31802db115

    Google Scholar 

  26. Le Saout J, Lefevre C, Kerboul B, Fenoll B, Miroux D, Courtois B (1987) Congenital elevation of the scapula (in French). J Chir (Paris) 124(3):181–183

    Google Scholar 

  27. McMurtry I, Bennet GC, Bradish C (2005) Osteotomy for congenital elevation of the scapula (Sprengel’s deformity). J Bone Joint Surg 87B:986–989. doi:10.1302/0301-620X.87B7.16148

    Article  Google Scholar 

  28. Klisić P, Filipović M, Uzelac O, Milinković Z (1981) Relocation of congenitally elevated scapula. J Pediatr Orthop 1(1):43–45

    Article  Google Scholar 

  29. Langlais J, Rigault P, Pouliquen JC, Padovani JP, Janklevicz P (1989) Long-term results of surgical treatment of congenital elevation of the scapula (in French). Rev Chir Orthop Reparatrice Appar Mot 75(5):318–328

    CAS  Google Scholar 

Download references

Acknowledgments

No funds were received in support of the study.

Author information

Authors and Affiliations

  1. 2nd Clinic of Orthopedics and Traumatology, Ankara Diskapi Teaching and Research Hospital, Diskapi, Ankara, Turkey

    Emel Gonen, Umit Simsek & Yalim Ates

  2. 2nd Clinic of Orthopedics and Traumatology, Ankara Atatürk Teaching and Research Hospital, Bilkent, Ankara, Turkey

    Sukru Solak & Bulent Bektaser

  3. 1st Clinic of Orthopedics and Traumatology, Ankara Diskapi Teaching and Research Hospital, Diskapi, Ankara, Turkey

    Erbil Aydin

  4. Asmabahce G-30, Koru, Ankara, Turkey

    Emel Gonen

Authors
  1. Emel Gonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Umit Simsek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sukru Solak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bulent Bektaser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yalim Ates
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erbil Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emel Gonen.

About this article

Cite this article

Gonen, E., Simsek, U., Solak, S. et al. Long-Term Results of Modified Green Method in Sprengel’s Deformity. J Child Orthop 4, 309–314 (2010). https://doi.org/10.1007/s11832-010-0265-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-010-0265-7

Keywords

Search

Navigation