Modified Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder

Abstract

Introduction: With a less than ideal health infrastructure and a vast underprivileged population in our country, many cases of Sprengel’s deformity are initially missed and are subsequently untreated. Although for best surgical results, the patient must be under the age of five, many patients present late at out tertiary care center. Thus, we evaluated the clinical results of the modified Woodward’s Procedure in such neglected cases. Methods: A retrospective study, of 16 patients aged 8-yr or above, with Sprengel’s deformity who underwent the modified Woodward’s procedure between 2006 and 2011. Clavicular osteotomy/morselization was avoided. The Cavendish scoring system was used to grade cosmesis and shoulder abduction was used to assess the functional outcome. The patients were prospectively followed up at two-years and after skeletal maturity. Results: There were ten females and six males and the average age was 9.4 years. The mean follow up was 4.2 yr. Omo- vertebral bar excision was done in 13 (81.25%) patients. The mean increase in postoperative shoulder abduction and Cavendish grades at a 2-yr follow-up were, 19.1° and 1.32 grades, respectively. None of our patients needed Clavicular osteotomy/morselisation and none developed neurological abnormalities. The was no change in the values at skeletal maturity. Conclusion: Satisfactory outcomes can be acquired by the Modified Woodward’s procedure in neglected Sprengel’s deformities. Besides a definitive cosmetic correction, the procedure also results in improvement of shoulder abduction. Clavicular Ostetomy/Morselization is not always required in cases presenting after the age of 8 years. Keywords: Woodward’s procedure; Sprengel’s shoulder, Cavendish grading, modified Woodward’s procedure; neglected Sprengel deformity.