Hypothesis: In the amyoplasia type of arthrogryposis, shoulder internal rotation, in addition to limited muscle development and joint contracture, may cause a reverse pronated grasp pattern. We hypothesized that repositioning the hands through external rotation distal humerus osteotomies (DHO) would allow for palm-to-palm grasp without crossover and would improve function and parent/patient satisfaction. Methods: The medical records of all patients treated surgically for arthrogryposis were reviewed at our hospital. Nine patients, 15 extremities, had undergone an external rotation distal humerus osteotomy to improve hand position. All patients had had preoperative and postoperative video recording of function. Preoperative upper extremity (UE) position was graded as 1 = facing away from midline, 2 = palm facing posterior, and 3 = palm facing midline. Postoperative Pediatric Outcomes Data Collection Instrument (PODCI) questionnaires were obtained, and parent satisfaction was evaluated. Results: Mean patient age at the time of surgery was 6.5 years. There were 6 patients who underwent staged, bilateral distal humerus osteotomies. There were a total of 3.5 additional upper extremity procedures in this population (range, 0-6). All patients had improved resting posture of the upper extremity after surgery, mean change 46° (range, 25°-90°). Thirteen extremities had a change in hand position affecting their grasp pattern, and 2 did not. There was a mean grade improvement of hand position of 1 level after surgery (range, 0-3). There was a wide range in postoperative PODCI scores for Upper Extremity Function and Global function, but Happiness scores were high, mean 89 (range, 60-100). Parents universally stated the procedure improved the child’s function “a great deal.” There was one complication of periprosthetic humerus facture. Summary Points: DHO is an effective procedure for correcting the internal rotation position of the UE in arthrogryposis. DHO improves hand opposition in arthrogryposis by a mean of 1 grade. Universally, there was perceived improved function resulting from DHO.
