Successful Realignment Research Articles

Distance stereopsis in patients with accommodative esotropia.

We aimed to evaluate distance stereoacuity (DS) in patients with successfully treated accommodative esotropia (AET) and its association with other clinical factors. The medical records of 176 children with refractive AET with a follow-up period ≥ 1year were reviewed to identify a cohort of patients who achieved a stable alignment within 4 prism diopters (PD) of orthotropia at both distance and near fixation. Age of onset, duration of misalignment, uncorrected near and distance deviation, accommodative convergence/accommodation ratio, refractive error, presence of anisometropia and amblyopia, near stereopsis were evaluated as predictors of outcome. DS was measured using the Distance Randot Stereo test and near stereoacuity by Randot Stereotest. The patient group was compared with 50 age-matched normal controls for DS. Fifty-six patients were included, and 38 patients had DS at the final visit. All patients with DS attained uncontoured near stereopsis (UCNS). UCNS was present only in 11 patients without DS (p = 0.001). Anisometropia (p = 0.997), uncorrected near deviation (p = 0.224), distance deviation with correction (p = 0.255), and high hypermetropia (p = 0.998) were not associated with DS. The multivariable regression model showed a significant positive correlation between UCNS and DS (OR = 31.14 (95% CI 2.25-430.48); p = 0.01). Contoured near stereopsis outcome was significantly different between the patients with and without DS (p = 0.001 for animals and p = 0.003 for circles). Compared with the control group, the patient group yielded lower DS scores (p = 0.001). Distance Randot Stereotest can be useful in measuring binocular vision recovery after successful realignment in refractive AET patients. Patients attaining normal scores for near stereopsis tests after optical correction revealed subnormal thresholds for DS.

Advancing large-scale thin-film PPLN nonlinear photonics with segmented tunable micro-heaters

Thin-film periodically poled lithium niobate (TF-PPLN) devices have recently gained prominence for efficient wavelength conversion processes in both classical and quantum applications. However, the patterning and poling of TF-PPLN devices today are mostly performed at chip scales, presenting a significant bottleneck for future large-scale nonlinear photonic systems that require the integration of multiple nonlinear components with consistent performance and low cost. Here, we take a pivotal step towards this goal by developing a wafer-scale TF-PPLN nonlinear photonic platform, leveraging ultraviolet stepper lithography and an automated poling process. To address the inhomogeneous broadening of the quasi-phase matching (QPM) spectrum induced by film thickness variations across the wafer, we propose and demonstrate segmented thermal optic tuning modules that can precisely adjust and align the QPM peak wavelengths in each section. Using the segmented micro-heaters, we show the successful realignment of inhomogeneously broadened multi-peak QPM spectra with up to 57% enhancement of conversion efficiency. We achieve a high normalized conversion efficiency of 3802% W−1 cm−2 in a 6 mm long PPLN waveguide, recovering 84% of the theoretically predicted efficiency in this device. The advanced fabrication techniques and segmented tuning architectures presented herein pave the way for wafer-scale integration of complex functional nonlinear photonic circuits with applications in quantum information processing, precision sensing and metrology, and low-noise-figure optical signal amplification.

How to overcome rent seeking in Tanzania’s skills sector? Exploring feasible reforms through discrete choice experiments

Skills gaps and mismatches are widely documented as a hindrance to inclusive structural transformation across developing countries, especially in Africa. What is often overlooked, however, is the fact that skills development is a complex political economy process challenged by institutional and financing problems on the supply side, and inadequate demand, that is, a shortage of firms that can organise skilled labour and provide on-the-job training effectively. In such adverse contexts, rent seeking and corruption may arise from conflicting objectives, trade-offs and mis-aligned incentives among stakeholders – public sector skills providers and firms. With a focus on Tanzania, we (i) analyse the incentive structures underlying such rule-breaking behaviours and processes, and (ii) empirically test alternative institutional design strategies that would better align the interests of different stakeholders towards improved skills development outcomes. Building on over 30 in-depth stakeholder interviews in 2018, we conducted three Discrete Choice Experiments with over 200 firms to test the feasibility of different incentive packages in 2019. Our main hypothesis is that the successful re-alignment of stakeholders’ incentives must consider both the different and potentially conflicting objectives of public training institutions and the heterogeneity in skills needs and capabilities of different types of firms. We uncover latent preference structures differentiated by observable firm characteristics, most strongly by differences in technical capabilities, existing training provision and firm size. We conclude advancing an evidence-based tailored skills policy reform.

One-piece Craniofacial Bone Fracture Reduction With an Additional Single Osteotomy at the Zygomaticomaxillary Buttress: A Successful Reduction of Frontoorbitozygomaticomaxillary Fracture Associated With a Temporoparietal Bone Fracture.

A frontoorbitozygomaticomaxillary fracture, also known as a complex midface fracture or "quadripod fracture," is a type of facial fracture involving multiple midface region bones. This includes the frontal bone (forehead), orbitozygomatic complex (which includes the zygomatic bone or cheekbone and the orbital bones around the eye), and the maxillary bone (upper jaw). These complex midface fractures associated with temporoparietal bone fractures can occur in clinical practice. However, a single-piece fracture of these has not been reported before. This study reports a 44-year-old male patient with a significant frontoorbitozygomaticomaxillary fracture associated with a temporoparietal bone fracture combined with epidural hematoma at the superior aspect of unilateral frontoparietotemporal convexity. Surgical treatment was performed 3 weeks after the traumatic event. Despite craniotomy of the parietal bone fragment, the reduction was not possible. The facial bone reduction was finally achieved following an additional single osteotomy at the unilateral zygomaticomaxillary buttress. The follow-up CT scan taken immediately and 3 weeks postoperatively showed successful realignment of craniofacial bone fracture. In conclusion, a single-piece fracture of frontoorbitozygomaticomaxillary bone connected to a temporoparietal bone can require additional osteotomy to achieve successful outcomes in an acute setting.

Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

The aim of this study was to analyze the specific patterns and risk factors of sagittal reconstruction failure in ankylosing spondylitis (AS)-related thoracolumbar kyphosis after pedicle subtraction osteotomy (PSO). A retrospective study was performed in patients with AS and thoracolumbar kyphosis after lumbar PSO with a minimum follow-up of 2 years. Patients were classified as having successful realignment (group A), inadequate correction immediately postoperatively (group B), and sagittal decompensation during follow-up (group C) according to the immediately postoperative and latest follow-up sagittal vertical axis (SVA). Radiographic parameters and clinical outcomes were collected. Pelvic tilt (PT) was used to assess the magnitude of pelvic backward rotation. Hip structural damage and ossification of the anterior longitudinal ligament (ALL) at the proximal junction, PSO level, and distal junction were also evaluated on radiographs. Overall, 109 patients with a mean age of 35.3 years were included. Patients in both group B (n = 16) and group C (n = 13) were older than those in group A (n = 80) (mean ages 43.6 vs 32.9 years, p < 0.011; and 39.2 vs 32.9 years, p = 0.018; respectively). Age (OR 1.102, p = 0.011), and preoperative PT (OR 1.171, p = 0.041) and SVA (OR 1.041, p = 0.016) were identified as independent risk factors of inadequate correction. Additionally, a higher distribution of patients with adequate ALL ossification at the PSO level was found in group B than in group A (37.5% vs 22.5%, p = 0.003). Age (OR 1.101, p = 0.011) and preoperative SVA (OR 1.013, p = 0.020) were identified as independent risk factors of sagittal decompensation. Furthermore, compared with group A, group C showed a higher distribution of patients with severe hip structural damage (15.4% vs 0, p = 0.018) and higher incidences of rod fracture (RF) (38.5% vs 8.8%, p = 0.011) and pseudarthrosis (15.4% vs 0, p = 0.018). Additionally, the incidence of RF (19.6% vs 6.9%, p = 0.045) and changes in the proximal junctional angle (0.5° vs 2.2°, p = 0.027) and the distal junctional angle (0.3° vs 2.2°, p = 0.019) were lower during follow-up in patients with adequate ALL ossification than in those without adequate ossification. Sagittal reconstruction failure in patients with AS could be attributed to inadequate correction immediately after surgery (14.7%) and sagittal decompensation during follow-up (11.9%). Adequate ALL ossification was a risk factor of inadequate correction. However, adequate ALL ossification could decrease the development of RF and relieve the junctional kyphotic change during follow-up. Older age and greater baseline SVA were independent risk factors for both inadequate correction and sagittal decompensation.

Augmented Lateral Rectus Recession for Consecutive Exotropia

ABSTRACT Purpose: To evaluate the efficacy of augmented bilateral lateral rectus recession in the treatment of consecutive exotropia. Methods: We retrospectively reviewed records of nine patients who underwent augmented bilateral lateral rectus recession for consecutive exotropia with minimal adduction deficits. Our normal surgical dosing tables for bilateral lateral rectus recession were augmented by adding 1.5–2 mm. All patients had been measured preoperatively using prism and alternate cover testing (PACT), except for one patient in whom Krimsky measurements were performed because of amblyopia. Surgery was deemed successful if postoperative alignment fell within a potential monofixation range of ±10 prism diopters (PD) by PACT at the final postoperative examination. Results: Eight out of nine patients (89%) had a successful outcome. One patient was surgically undercorrected. Despite successful realignment to a state of monofixation syndrome in most patients, there was no significant restoration of stereopsis following strabismus surgery. Conclusions: Surgical augmentation of bilateral lateral rectus recession standard dosing by 1.5–2 mm is efficacious for restoring binocular alignment for both distance and near fixation. This surgical approach may be preferable to bimedial advancements in patients with minimal preoperative adduction deficits who show no significant increase in exotropia during near fixation.

The role of the right posterior parietal cortex in prism adaptation and its aftereffects

Adaptation to optical prisms (Prismatic Adaptation, PA) displacing the visual scene laterally, on one side of visual space, is both a procedure for investigating visuo-motor plasticity and a powerful tool for the rehabilitation of Unilateral Spatial Neglect (USN). Two processes are involved in PA: i) recalibration (the reduction of the error of manual pointings toward the direction of the prism-induced displacement of the visual scene); ii) the successive realignment after prisms’ removal, indexed by the Aftereffects (AEs, in egocentric straight-ahead pointing tasks, the deviation in a direction opposite to the visual displacement previously induced by prisms). This study investigated the role of the posterior parietal cortex (PPC) of the right hemisphere in PA and AEs, by means of low frequency repetitive Transcranial Magnetic Stimulation (rTMS). Proprioceptive and Visuo-proprioceptive egocentric straight-ahead pointing tasks were used to assess the presence and magnitude of AEs. The primary right visual cortex (V1) was also stimulated, to assess the selectivity of the PPC effects on the two processes of PA (recalibration and realignment) in comparison with a cortical region involved in visual processing. Results showed a slower adaptation to prisms when rTMS was delivered before PA, regardless of target site (right PPC or V1). AEs were reduced only by PPC rTMS applied before or after PA, as compared to a sham stimulation. These findings suggest a functional and neural dissociation between realignment and recalibration. Indeed, PA interference was induced by rTMS to both the PPC and V1, indicating that recalibration is supported by a parieto-occipital network. Conversely, AEs were disrupted only by rTMS delivered to the PPC, thus unveiling a relevant role of this region in the development and maintenance of the realignment.

240. Spinopelvic alignment and successful outcomes following cervical deformity correction

BACKGROUND CONTEXT Surgical correction of cervical deformity (CD) can improve a patient's functional status, but is often associated with suboptimal radiographic and clinical outcomes. Although prior studies have demonstrated a high prevalence of thoracolumbar deformity among CD patients, correction of the cervical deformity often fails to address global malalignment, which may contribute to the high rates of treatment failure. The relationship between global alignment and successful CD correction remains unclear. PURPOSE To investigate whether spinopelvic alignment (SPA) is associated with outcomes following CD correction STUDY DESIGN/SETTING Retrospective review of a prospective CD database PATIENT SAMPLE A total of 97 patients with CD. OUTCOME MEASURES One-year cervical alignment, Neck Disability Index (NDI) scores, distal junctional kyphosis (DJK). METHODS A database of operative CD patients was analyzed. Inclusion criteria: cSVA>4cm or C2-slope>20°. Failure was defined as: 1-year cSVA >4cm, NDI change 20°). Failed surgeries were compared with respect to pelvic angles (TPA, T10PA, C2PA), C2-pelvic tilt (CPT), and pelvic incidence (PI). Age- and PI-specific alignment targets were calculated for TPA and T10PA. RESULTS A total of 97 CD patients were included (mean 62±11y, 62%F). At 1 year 57% had alignment failure, 39% failed to reach NDI MCID and 12% developed DJK. 66% had baseline thoracolumbar malalignment (>1 +Schwab modifier). Alignment failure was associated with worse BL cervical alignment and higher rate of DJK (16% vs 2%), all p 48.5 reached NDI MCID( CONCLUSIONS Two-thirds of CD patients had concurrent TL deformity. Patients with failed alignment had worse BL CA, but successful cervical realignment was not associated with NDI improvement. This study demonstrates that SPA is associated with radiographic and clinical outcomes following CD correction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Reliability of two techniques and training level of the observer in measuring the correction angle when planning a high tibial osteotomy

BackgroundIn high tibial osteotomy, planning is critical for achieving successful realignment. Any method selected needs to be reliable, with inter-observer and intra-observer correlation. A literature review demonstrated two distinct methods of planning for high tibial osteotomy.Hypothesis: Both methods are precise and show excellent inter and intra-observer correlation. MethodFifty consecutive weight-bearing long leg alignment antero-posterior (AP) radiographs were identified and planning undertaken on suitable radiographs using the methods of Puddu (method 1) and Miniaci (method 2). Two observers, one junior trainee and one Specialist Knee Fellow, recorded measurements to calculate inter and intra-observer correlation. ResultsThirty-two radiographs were included. Inter-observer and intra-observer correlation, and correlation between the two methods were all greater than 0.97 (p<0.0001). ConclusionOur results show excellent correlation between both methods and both observers. Both methods are reliable for planning and can be performed by both junior trainees and subspecialists. Further work should consider how planning can ensure adequate intraoperative correction.

Firms’ capabilities for sustainable innovation: The case of biofuel for aviation

Innovation is one of the increasingly important means by which companies can contribute to sustainable development. The shift of focus in business from competitiveness alone, to the combination of sustainability and competitiveness impacts firms’ capabilities for innovation. This process study aims to investigate what the organizational and managerial capabilities through which companies can innovate for sustainability are, referred to as dynamic capabilities for sustainable innovation. We address this question through a retrospective longitudinal case study of the attempts of the KLM Royal Dutch Airlines (KLM), which uses its influential position in the value chain to stimulate production and use of biofuel for aviation. The study identifies critical organizational and managerial capabilities that are forming the basis of the successful realignment of a firm’s dynamic capabilities with its sustainable innovation strategies. We explain how these capabilities are built and strengthened for sustainable innovation and how these capabilities function throughout the development process of sustainable innovation. This study aims to contribute to a further theoretical and practical understanding of how capabilities are deployed by firms to create and implement sustainable innovation.

Launching of Leigh Road Bridge, Slough, UK

Leigh Road Bridge, a road-over-rail bridge crossing the Great Western route in Slough, UK, is believed to be only the second bridge in the country to have been launched across a railway using trailers. It is also one of the largest structures constructed by this method anywhere in the world. During the sliding stage of the launch a significant unforeseen incident occurred when the launch structure nose suddenly slid laterally, damaging some of the key temporary works. The project team worked collaboratively to restore the position and complete the launch without disruption to rail traffic and open the scheme to road traffic on time. Both the methodology and the successful realignment operation led to important conclusions and learning points for future launches of this type.

Progress in improving the protection of species and habitats in Australia

Historically, protected areas were often designated using criteria other than biodiversity conservation as the primary objective. With the emergence of the science of systematic conservation planning, the designation of new protected areas is increasingly made with explicit conservation objectives in mind. However, assessments of the performance of protected area systems typically include all protected areas, regardless of when they were designated, potentially obscuring recent improvements in conservation planning decisions. Thus, it is often unclear to what extent systematic conservation planning principles have influenced the placement of new protected areas. Here, we compare recently designated protected areas in Australia with the protected area system that existed prior to the introduction of systematic conservation planning guidelines in 2000. We ask whether there is a difference between past and recent protection in terms of (i) the size and spatial distribution of protected areas, (ii) the characteristics of broad regions in which protection is concentrated, and (iii) the extent to which protected areas represent ecosystems and threatened species in comparison with selecting protected areas at random. We find that the protected area system was historically biased toward areas with steep slopes and low human populations. In contrast, recent protection is more likely to be allocated to regions with high human population and high numbers of threatened species; we show that this effect is not simply a result of biases in the places now available for conservation. Despite this successful realignment of practice, we find that the increase in protected area coverage in poorly protected regions has occurred more slowly than expected if protected area selections were fully guided by systematic conservation planning principles. Our results demonstrate rapid progress in improving Australia's protected area system in the last decade, and highlight the importance of separating recent from historical additions to the protected area system when measuring the performance of conservation decision-making.

Preoperative Factors Affecting Stereopsis after Surgical Alignment of Acquired Partially Accommodative Esotropia

Background/Aim: Despite successful ocular realignment, many strabismus patients never develop high levels of stereopsis. The purpose of this study was to determine preoperative factors that affect postoperative stereopsis in patients with acquired partially accommodative esotropia (APAET).Methods: This was a retrospective chart review of patients who underwent successful surgery for APAET. We compared preoperative factors between patients achieving postoperative stereopsis of 100 seconds of arc or better versus those with worse than 100 seconds of arc.Results: Fifty-seven patients met our inclusion criteria. Twenty-four (42%) had a final stereopsis of 100 seconds of arc or better. The mean age of onset of esodeviation for patients attaining stereopsis of 100 seconds of arc or better was 31.8 ± 12.9 months, versus 23.9 ± 10.0 months (p = 0.012) for patients with worse than 100 seconds of arc. Duration of constant misalignment was not significantly different between the two groups (30.1 ± 18.5 for patients attaining 100 seconds of arc versus 27.3 ± 18.6 months; p = 0.57). A multivariate regression analysis found older age of onset to be the only predictive factor for achieving better postoperative stereopsis (odds ratio 1.065, 95% CI: 1.014–1.118).Conclusion: Age of onset appears to be the most important factor affecting postoperative stereopsis in patients with APAET. Patients with an age of onset after 36 months tended to have better outcomes regardless of the duration of misalignment. Duration of misalignment and age at surgery did not have a significant impact on postoperative stereopsis in our patient population.

The Efficacy of Primary Interventional Urethral Realignment for the Treatment of Traumatic Urethral Injuries

PurposeTo evaluate the efficacy of primary interventional urethral realignment (PIUR) in patients with traumatic urethral injuries. Materials and MethodsThis retrospective study included 13 patients with traumatic urethral injuries who were treated with PIUR between September 2008 and February 2014. All 13 patients were men with the mean age of 56.3 years. Technical success rate of PIUR, time to PIUR, required procedure time, length of hospital stay, duration of urethral catheterization, and complications after PIUR were investigated. ResultsPIUR was technically successful in 12 of 13 patients (92.3%). The mean time from trauma to PIUR was 44 hours (range, 1–240 h). The mean procedure time was 20.2 minutes (range, 3–90 min). The median length of hospital stay was 15 days (range, 1–60 d). The mean duration of urethral catheterization after PIUR was 25 days (range, 9–65 d). There were no immediate complications related to PIUR, although 6 of 12 patients developed symptomatic urethral stricture after PIUR. The mean time to stricture development after PIUR was 4.3 months (range, 2–12 mo). Of the 6 patients, 2 were treated with endoscopic internal urethrotomy, and 4 were treated with interventional radiologic urethral balloon dilation. ConclusionsPIUR can be safe and effective for patients with traumatic urethral injuries. However, symptomatic stricture formation occurred in one-half of the successful realignment procedures.

Ultrasound-Assisted Pediatric Forearm Fracture Reduction Doesn't Supplant Radiography

In a prospective study of children undergoing closed reduction of a single-bone forearm fracture at a pediatric emergency department, investigators assessed the test characteristics of point-of-care ultrasound for determining successful realignment. Fractures requiring realignment of both forearm bones and those …

Accuracy of Ultrasonography for Determining Successful Realignment of Pediatric Forearm Fractures

The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician. A cross-sectional study was conducted in children younger than 18 years and presenting to an academic emergency department with forearm fractures requiring realignment of a single bone. Physicians performed closed reductions with ultrasonographic assessment of realignment until the best possible reduction was achieved. Fluoroscopy was then immediately performed and images were saved. A positive test result was defined as an inadequately reduced fracture on fluoroscopy by a blinded pediatric orthopedic surgeon (reference standard) and on ultrasonography (index test) and fluoroscopy in real-time by the treating physician. One hundred patients were enrolled (median age 12.1 years; 74% male patients); the radius was involved in 98%, with 27% involving the growth plate. The sensitivity, specificity, positive predictive value, and negative predictive value were 50% (95% confidence interval [CI] 15.4% to 84.6%), 89.1% (95% CI 82.8% to 95.5%), 28.6% (95% CI 4.9% to 52.2%), and 95.3% (95% CI 90.9% to 99.8%), respectively. The treating physicians' agreement rate of the real-time images was 98%. Point-of-care ultrasonography can help emergency physicians determine when pediatric forearm fractures have been adequately realigned, but inadequate reductions should be confirmed by other imaging modalities.

The slippery slope: early signs of instability after surgery for esotropia

Reoperation rates for strabismus surgery remain high even after initial successful realignment. We studied onset of instability with longitudinal analysis comparing postoperative outcomes of esotropia surgery at 2-4 months versus 1 year.

To evaluate stereoacuity in patients with acquired esotropia and to determine factors associated with favourable outcomes.

Aim:To evaluate stereoacuity in patients with acquired esotropia and determine the factors associated with favorable outcomes.Materials and Methods:A total of 68 subjects aged 6 years and above were included in the study. Thorough clinical evaluation including binocular status examination using the Bagolini-striated glass test, The Netherland Organization (TNO), and Randot stereo test were done. The subjects were divided into two groups 1 and 2, based on the amount of deviation. Statistical analysis of the result was performed.Result:The duration of misalignment in the group with deviation less than or equal to 8 prism diopters (PD) was 1.49 ± 0.86 years, whereas in the group with deviation more than or equal to 10 PD was 4.64 ± 2.99 years (P = 0.000). Among the subjects in group 1, 89.5% achieved fusion and 52.6% had stereoacuity on both TNO and Randot, whereas in group 2 40% achieved fusion and 3.3% stereopsis on both TNO and Randot (one case with only coarse stereopsis). A subanalysis within group 1 revealed a statistically significant difference for the duration of misalignment (P = 0.02), but a marginal difference for the amount of deviation (P = 0.3).Conclusion:A horizontal deviation up to 8 PD was compatible with stereopsis. Also, the duration of constant misalignment affects the attainment of stereopsis despite successful realignment.

Strabismus in Cerebral Palsy: When and why to Operate

Cerebral palsy (CP) is the most common physical disability in children. Orthoptists and ophthalmologists who care for children with CP know that strabismus is a common feature. This paper reviews the literature on strabismus in patients with CP, and then provides summary data and recommendations for management of these patients. The incidence of strabismus in patients with CP, especially in patients with spastic diplegia, is much higher than in neurologically normal children. Esotropia is the most common ocular misalignment. CP patients with strabismus benefit from nonsurgical treatment and should be treated promptly. Strabismus surgery should be considered in CP patients for psychosocial reasons as well as for potential successful ocular realignment and restoration of binocular vision. The literature is lacking in a long-term natural history study, prospective strabismus surgery studies, and long-term outcome studies of strabismus management in patients with CP.

Correction in Malrotation of the Scapula and Muscle Transfer for the Management of Severe Sprengel Deformity

The clinical results of surgical procedures for severe Sprengel deformity have been uncertain. To obtain improved elevation, we consider that it is necessary to realign the lateral border of the scapula for upward rotation. The purposes of the current study were to evaluate the clinical results and range of motion of the scapula after such realignment. Seven cases of Sprengel deformity of Cavendish grade 3 or 4 were treated surgically and then clinically evaluated and examined using 3-dimensional computed tomography (3D CT). (Two boys and 5 girls aged 50.9 ± 15.4 mo, mean ± SD at the time of operation.) The mean follow-up was 53.1 months (range, 12 to 92 mo). After the omovertebral bone and the superomedial side of the scapula were removed, the levator scapulae and rhomboids were reattached to wrap around the scapula at maximum upward rotation to assist in maintaining this position. Cavendish and Rigault grades were used for evaluation of postoperative appearance. The superior displacement and rotation of the scapula were measured on the trunk posterior view using 3D CT. The relationship between improvement in the range of motion and radiologic change were analyzed statistically. The postoperative flexion (97.9 ± 12.9 to 160 ± 11.5 degrees) and abduction (99.3 ± 13.0 to 161.4 ± 15.7 degrees) were significantly improved compared with the mean preoperative values (P < 0.0001). 3D CT revealed that in all patients the malrotation of the scapula was improved postoperatively. The current study shows that successful realignment of the scapula led to these improved clinical results. Our procedure has advantages not only for recovery of the range of motion but also for reducing the characteristic lump in the web of the neck. However, our procedure has an inherent limitation related to asymmetric shoulder level and width. 3D CT may be useful for preoperative planning and postoperative evaluation. Level IV-case series.