Abstract
Introduction: Sprengel deformity is also named High Congenital Scapula (HCS).
It is a rare abnormality in children of which consequences are cosmetic and functional too.
Purpose: It is to assess those anatomic findings which have a prognostic value and to focus on the main stages of the treatment.
Material and Methods: We reviewed a series of 23 cases of HCS in 19 children, 4 of whom having had a bilateral involvement. In all the cases, the elevation of the scapula was accompanied by a rotation and a varus position of the glena.
The age of our patients ranged from 6 months to 13 years old. 50% of them were younger than 9 at the first visit. Functional consequences consisted in a modification of the plan of the movements of shoulder. Besides the omovertebral bone, many important abnormalities – mainly of the spine – have been noticed in our series.
The cases were classified using the degree of elevation of the superomedial angle of scapula. Three grades could be set up.
Concerning the treatment, 2 children have not been operated on. In the other cases, we used a modification of the Woodward procedure.
Results: Two cases were judged to have a poor result. One case had a fair result.
79% were considered as good on both aspects, cosmetically and functionally, with no complication.
The age at which surgery has been performed seems to have no influence on the result. On the opposite, the number and the severity of the anatomic anomalies have to be taken into consideration for the prognostic assessment.
Discussion: As comparing our results with those of the other series, we could notice that our procedure is less aggressive. Indeed, the majority of the surgical procedures mention a resection of a part of the scapula. In such a way, the cosmetic result can be easily improved, even if the scapula has not been really lowered. On the other hand, the anti-varus stage of our procedure improves the plan of movements of the shoulder.
Conclusion: The Sprengel deformity could need surgical correction in the moderate and major deformities. Surgery shall lower the scapula as much as possible, but it shall avoid neurologic or vascular complications. At last, surgery is first indicated for improving the biomechanics of the scapular girdle.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
