A retrospective observational study to assess the post-operative functional outcomes following Modified Woodward’s procedure in patients with Sprengel’s deformity

Anand, A (2016) A retrospective observational study to assess the post-operative functional outcomes following Modified Woodward’s procedure in patients with Sprengel’s deformity. Masters thesis, Christian Medical College, Vellore.

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Abstract

AIM: To evaluate the Cosmetic, radiological and functionaloutcomes of modified Woodward’s procedure in patients with Sprengel’s deformity. OBJECTIVES: 1. To assess Cavendish score for cosmetic improvement 2. To assess Rigault’s score, height‐width ratio of the scapula and superior displacement ratio for radiological improvement. 3. To assess the PODCI (Paediatric outcomes data collection instrument) and simple shoulder test (SST) shoulder scores for functional improvement METHODS: In this retrospective observational study, fourteen out of twenty two patients with Sprengel’s deformity who underwent modified Woodward’s procedure with a minimum of one year follow‐up were included and examined. The patients who underwent surgery between January 2006 – August, 2014 under the Paediatric Orthopaedics unit in CMCH Vellore were included in this study. Preoperative findings were noted including patient’s detailed historyand clinical, radiological & functional evaluationwere done at follow‐up.Cavendish grading was used to evaluate cosmetic appearance. Range of motion, Paediatric outcomes data collection instrument ( PODCI) and simple shoulder test (SST) were obtained to evaluate shoulder function. Scapula placement and degenerative disease were assessed by radiographic examination and by the Rigault’s classification. Statistical analysis was done using STATA v.13 software. Paired t‐test was used for the paired analysis of preoperative and final values of Cavendish grade, range of abduction, ratio of superior displacement and height‐ width ratio. The Rigault grade and Forward flexion are not normally distributed in the population; we therefore used the Wilcoxon signed rank test RESULTS: Out of twenty two Children who underwent Modified Woodward’s surgery, only fourteen patients were available for follow‐ up . No patients had prior shoulder surgery. Out of fourteen patients, three were boys, eleven were girls. They were operated at a mean age of 5.7 years (range 3‐12). Four patients had been operated on right side, nine patients on left & one underwent bilateral correction. Six patients had associated anomalies. Mean follow up was 54 months with the mean abduction of the shoulder improved from 107.10 preoperatively (90‐130) to 143.57 post‐operatively (100‐1700). The mean forward flexion* improved from 120.0 preoperatively (100.0,130.0) to 160.0 post‐operatively (150.0,160.0). The abduction range of movements had an improvement of 36.50 with significant increase (P<0.001). The forward flexion also showed a statistically significantimprovement of 400(P=0.0008). There was a mean cosmetic improvement by Two Cavendish Grades in all 14 shoulders. The preoperative Cavendish grade mean was 3.43 to post‐op 1.42 with a significant P‐value <0.001.Radiological improvement of scapular lowering was assessed by Rigualt’s grade* which showed preoperatively mean 2.5 (2.0, 3.0) to post‐op 1.0 (1.0, 1.0) grade with significant p‐value of 0.0006.Other radiological assessment such as Superior displacement ratio showed significant improvement with p‐value of 0.0001 (pre‐op‐0.40 compared to post‐op of 0.28). Height/width ratio was improved with a p‐value of 0.008. No signs of degenerative changes were found in shoulder joints at follow‐up radiologically. The mean scapular lowering was 2.01cm.Evaluation of questionnaires with PODCI score & SST at follow‐up showed mean PODCI Score of 83.21 (Range – 58‐100) & mean SST score of 9.7 points. (Range 8‐12). One patient who was operated at the age of 5 years sustained a post‐operative brachial plexus inury , however she was not included in the study due to inadequate follow‐up. No patients had surgical scar complications like wound necrosis or keloid formation. Hypertrophic scar formation was seen in two patients. CONCLUSION: In conclusion our study showed significant improvement in cosmesis, radiological parameters, range of motion, scapular position and function following the Modified Woodward’s procedure. The results obtained were in concordance with the published literature. We find this a safe and predictable method with very few complications. We suggest avoiding the modification of anchoring the inferior angle of scapula to the T9spinous process based on the single significant complication of a brachial plexus injury in a 5years old child.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Sprengel’s deformity ; Modified Woodward’s procedure ; Wood wards surgery ; Cavendish score ;PODCI.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 21 Sep 2017 03:05
Last Modified: 21 Sep 2017 03:05
URI: http://repository-tnmgrmu.ac.in/id/eprint/3224

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