Shoulder Osteotomy
The shoulder osteotomy surgery procedure that cuts and reshapes bones can be performed to fix problems in many different bones and for damaged joints. Osteotomy involves cutting of the bone and hence this is ideal to shorten or lengthen a deformed bone that does not align with a joint as required. Osteotomy these days is not just performed on old people as many young, healthy people are opting for osteotomy as a way to postpone total shoulder replacement for many years. Eligible candidates for shoulder osteotomy need to have uneven joint damage, or a deformity that is correctable and also there should not be any signs of inflammation. Earlier osteotomy was done for older children with dislocated shoulders.
In osteoarthritis of the shoulder, the osteotomy procedure can help to remove a portion of bone near the joint that is affected by arthritis to shift the weight away from the deteriorated cartilage to a more normal or healthy cartilage. The effect of osteotomy on the glenohumeral joint is that it can increase the posterior dislocation of the humeral head as this is where the head of the humerus is located. When the pain arising in the glenohumeral joint in osteoarthritis or rheumatoid arthritis is much prolonged and affecting sleep then a double osteotomy may help relieve it.
Osteotomy has found to provide a feasible treatment option for patients with brachial plexus birth palsy who may have advanced glenohumeral dysplasia that prevents soft-tissue releases and tendon transfers. In this case a de-rotational humeral osteotomy improves shoulder function. Even shoulder internal rotation deformity can be successfully treated by an osteotomy surgery. Such deformity should be secondary to malunion of fracture and for stabilization of anterior dislocation like in the Hill-Sachs defect. In other types of dislocation an external rotation osteotomy may be used as a stabilization technique. In the case of coracoid impingement syndrome which is a rare cause of anterior shoulder pain, coracoid osteotomy has been found to be favorable. Coracoid osteotomy with internal fixation can allow good stability with a reliable direct bone-to-bone healing.
The journey towards osteotomy surgery begins with a detailed assessment to discover if the damage to your shoulder is treatable using this technique. In the recent years the imaging of the skeleton has become highly accurate and because of that osteotomy surgery can be planned accurately to within a fraction of a millimeter. Computer assisted surgery that has been planned using accurate CT scans helps the surgeon to operate according to the individual need of each patient. The advances in surgical instruments ensure that the accurate measurements obtained in the planning stage are translated into accurate bone fixation using much improved metal plates and pins. Osteotomy surgery itself may take from 1-2 hours depending on the complexity and you can expect to stay in hospital for 2-3 days afterwards. An osteotomy is basically a surgically induced fracture. Like other fractures, they can take about 6 weeks to heal. The discomfort will get better after the first two weeks following surgery.
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Q&As on Shoulder Dislocation in Children
1.What are the different kinds of shoulder dislocation?
Shoulder dislocation occurs when the ligaments that attach your child’s arm to their shoulder come under so much pressure that the ball in the top of their arm bone gets dislocated from the shoulder socket. Three types of shoulder dislocation can happen to your child:
- Anterior shoulder dislocation occurs when the humeral head moves out of the glenoid when the arm is struck while getting held out. In such a kind of shoulder dislocation, the ball of the humerus is pushed in the forward direction.
- A posterior dislocation occurs when the humeral head is pushed back from the glenoid because of falling onto the outstretched hand or a direct blow to the front part of the shoulder.
- The third kind of shoulder dislocation occurs when one of the ligaments that connect the humeral head to the glenoid is torn or stretched. Some issues with the rotator cuff or the shoulder bones also cause the shoulder to dislocate.
2.When does a shoulder dislocation need surgery?
When a conventional program of exercises fails to treat shoulder dislocation, surgery is considered. Surgery is the right treatment when your child gets repeating episodes of shoulder dislocations, or their shoulder dislocation impacts their capability to use their arm. The primary goal of surgery for shoulder dislocation is restoring stability while upholding shoulder mobility and offering painless movements. During the procedure, the surgeon tightens the stretched ligaments or repairs the labrum if it is torn during injury. Some shoulder dislocation is treated through arthroscopy, a slightly invasive surgical process of diagnosing and treating joint injuries by making small incisions. But in several cases, doing open surgery is more efficient in repairing the instabilities in the shoulder. The success rate for treating shoulder dislocation through surgery is 90 – 95 percent.
3.Can we prevent a child from getting repeated shoulder dislocation?
A child can recompense for loose ligaments by enhancing the strength and control of the rotator cuff and the shoulder blade muscles. These groups of muscles assist in pulling the humeral head into their glenoid and pull in more tightly when they are strong. The rehabilitation program for a child to prevent shoulder dislocations might include the following:
- Some exercises include secure grip pulling downs, paddling on a machine, and shrugs to gain strength in shoulder blades.
- Programs for strengthening the rotator cuff include some rotation exercises keeping the arm down at one side.
- Exercises for enhancing shoulder coordination by using a medicine ball and all bouncing balls against the floor and the walls.
4.What are the consequences of not fixing the shoulder dislocation in your child?
When the shoulder dislocation of your child is left untreated, it increases pain and swelling. You must visit a doctor as early as possible when your child has a shoulder dislocation.
5.How long does a shoulder dislocation take to heal for a child?
How fast your child will recover from a shoulder dislocation depends on the injury’s seriousness. Separated shoulders might heal in 6 weeks, but dislocated shoulders might take a long time, around 3-12 weeks. But it would help if you remembered that this timing is simply an approximation and everybody will heal at varied rates.
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