Humeral Rotational Osteotomy for Shoulder Deformity in Obstetric Brachial Plexus Palsy: Which Direction Should I Rotate?

Amr A Abdelgawad*, Miguel A Pirela-Cruz
Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Science Center at El Paso, TX, USA

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© Abdelgawad and Pirela-Cruz; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Orthopedic surgery, Texas Tech University Health Science Center at El Paso, TX, 4801 Alberta Ave, El Paso, TX 79905, USA; Tel: 915-215-5407; Fax: 915-545-6704; E-mail:


Shoulder internal rotation contracture is the most common deformity affecting the shoulder in patients with Obstetric Brachial Plexus Palsy. With progression of the deformity, the glenohumeral joint starts to subluxate and then dislocates. This is accompanied with bony changes of both the humerus and the glenoid. Two opposite direction humeral osteotomies have been proposed for this condition (internal rotation osteotomy (IRO) and external rotation osteotomy (ERO)). This fact of different direction osteotomies has not adequately been explained in the literature. Most orthopedic surgeons may not be able to fully differentiate between these two osteotomies regarding the indications, outcomes and effects on the joint. This review explains these differences in details.

Keywords: Erb's Palsy, external rotation, glenohumeral joint, humeral osteotomy, internal rotation, internal rotation deformity, obstetric brachial plexus palsy (OBPP), shoulder dislocation..