Shoulder Motion Following Combined Glenoid Anteversion Osteotomy Compared with Soft Tissue Rebalancing Alone for Brachial Plexus Birth Injury
Bibliographic record
Abstract
Background: Muscle rebalancing improves shoulder internal rotation contracture due to brachial plexus birth injury but is less effective for correcting marked glenohumeral dysplasia. For severe cases, combining glenoid anteversion osteotomy (GAO) with subscapularis lengthening and tendon transfers is an alternative to external rotation osteotomy of the humerus. We asked how the addition of glenoid osteotomy affects shoulder motion. Methods: We defined 2 groups who underwent very similar procedures with the exception of GAO: GAO group-combined GAO, subscapularis slide, and tendon transfers for severe glenohumeral dysplasia, and non-GAO group-subscapularis slide and tendon transfers without GAO for cases of milder dysplasia. We compared active and passive rotation, Active Movement Scale (AMS) and Mallet scores. Results: We compared 86 children in the GAO group with 74 children in the non-GAO group with median follow-ups of 58 (IQR1-3:22-101) and 46 (IQR1-3: 24-72) months, respectively. Preoperatively, the children in the GAO group were older (median 79 (range 14-210) months vs. 34 (range 6-204) months) and exhibited a relatively severe distribution of glenohumeral dysplasia than those in the non-GAO group, as expected. The extent of active external rotation (ER) in adduction improved postoperatively in the GAO group by 65° (p < 0.05), and in the non- GAO group by 84° (p < 0.05). Despite loss of the mean end range of internal rotation by 31° and 27°, the total arc of rotation increased by 34° and 57° in the GAO and Non-GAO groups, respectively. At final follow-up, active ER at 90° abduction (p = 0.14), passive ER (p = 0.17), total arc of rotation (p = 0.11), AMS ER (p = 0.45), Mallet global ER (p = 0.9), and Mallet composite (p = 0.9) scores were similar between the groups, irrespective of the glenoid osteotomy. Conclusion: The 2 approaches compared here resulted in similar functional outcomes despite different initial severities of glenohumeral dysplasia. Addition of GAO for severe cases does not obviate improved motion. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".