Modified Woodward's procedure confers functional improvement in Sprengel's deformity

Abstract

Modified Woodward's procedure improves shoulder movement and cosmesis. There is a paucity of literature reporting objective assessment of functional outcomes. We report cosmetic and functional outcomes in Sprengel's deformity treated with modified Woodward's procedure. Children aged 12 years and under, who underwent Modified Woodward's procedure from January 2006 to December 2014 were included in the prospective study. Improvement in Cavendish grade, Rigault scale, and shoulder movements was noted. Pediatric outcomes data collection instrument (PODCI) and simple shoulder test (SST) scores were assigned at the final follow-up. Statistical analysis was conducted with paired T-test and Wilcoxon signed-rank tests. Fourteen patients (one bilateral) with a mean follow-up of 4.5 years (1-8 years) were analyzed. The mean age at surgery was 5.7 years (3-12 years). Ten (71%) patients had omovertebral bars. Six patients had Klippel-Feil syndrome including one with cervical hemivertebrae with anterior chest wall deficiency. Cavendish grade and Rigault scale improved significantly (P < 0.05). Mean shoulder abduction and forward flexion improved by 37.3° (P < 0.001) and 38.7° (P < 0.001), respectively. The mean normative PODCI score was 24.07 (reported normative score ranges from -146 to 53) and the SST score was 9.64 (reported score ranges from 0 to 12). SST scores demonstrated a moderate correlation with shoulder function. Patients without associated anomalies had better cosmetic (P = 0.057) and functional (P = 0.029) improvement. Modified Woodward's procedure improved cosmesis and provided near-normal functional outcomes in children irrespective of age and sex. Better improvement was noted in children without anomalies.