Humeral Lengthening in Erb’s Palsy

A 10 year old girl presented with a deformed right humerus. The patient had weakness of the muscles due to the Erb palsy. There was a history of having undergone a previous osteotomy of the proximal humerus to derotate the arm, which resulted in malunion of the humerus in the form of anteromedial angulation, and shortening of 8 cm. There was marked limitation of shoulder abduction and external rotation and neurologic deficit consistent with the Erb palsy. An Ilizarov external fixator was applied to the humerus, and corticotomy was performed through the scar of the previous operation at the apex of the deformity. After a latency period of 1 week, distraction was begun at a rate 1 mm per day in divided doses. At the end of gradual lengthening and correction of the angulation, she then had an acute derotation procedure done by adjusting the external fixator acutely in the clinic. The only complication encountered was pin tract infections, which were treated by parenteral antibiotics. Follow-up after 3 years revealed improvement of the abduction and external rotation range of motion.Erb's palsy