Page 40 - Delaware Medical Journal - September/October 2018
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FIGURE 2. 17-year-old boy with severe OI.
2A. AP view of the left shoulder demonstrating
a downward
hook of the
distal third of
the clavicle, with almost complete envelopment of the humeral head in the acromion process.
2C. Skin markings of
the clavicle
and acromion process and the acromioclavicular (AC) joint in the same patient as Figures 2A and 2D.
2B. An AP view of the left shoulder of an age- and gender- matched patient without OI, highlighting the dramatic nature of the deformity in the setting of severe OI.
2D. An AP view of the
left hip in the same patient with severe OI, demonstrating the similarities between acetabular and shoulder protrusio.
FIGURE 3. 12-year-old boy with severe OI.
3A. AP view of the right shoulder in a 12-year-old boy with severe OI undergoing right humeral realignment and intramedullary rodding with notable shoulder protrusio, necessitating
a retrograde approach for the rodding procedure.
3B. AP view of the right humerus in the operating room, immediately following the retrograde realignment and intramedullary rodding of the right humerus.
the lateral clavicle through the arthroscopic approach known as the Nevaiser portal. We have described an alternative method of contending with the acromial protrusio by using a retrograde approach to the humerus through the lateral column of the distal humerus.14
Limitations of this report include its descriptive, subjective nature. Future investigations include
a systematic review of shoulder radiographs in the OI population as well as work with advanced imaging modalities. It is important to understand the potential impact of this shoulder deformity in the OI population because it not only affects surgical procedures and outcomes but also may predispose to proximal humerus fractures in
the same way acetabular protrusio is associated with femoral neck fractures.5 The potential impact of this shoulder deformity on range of motion, predisposition to rotator cuff pathology, and the ability to perform daily activities and wheelchair athletics is also unknown. Only by establishing shoulder protrusio as a clinical
and establishing a means to measure the bony deformity and evaluate the soft-tissue envelope with patient characteristics, establish those at risk for pathology, and identify potential treatment interventions or preventative measures.
CONTRIBUTING AUTHORS
■ JEANNE M. FRANZONE, MD is a Pediatric Orthopedic Surgeon at the Nemours A.I. duPont Hospital for Children in Wilmington, with a speciality in pediatric limb deformity.
■ MICHAEL B. BOBER, MD, PhD is the Director of the Skeletal Dysplasia Program at the Nemours A.I. duPont Hospital for Children.
■ Kenneth J. Rogers, PhD, ATC is the Program Manager for Clinical Research with the Department of Orthopedic Surgery at the Nemours A.I. duPont Hospital for Children.
■ RICHARD W. KRUSE, DO, MBA is a Clinical Professor of Orthopedic Surgery and a pediatric orthopedic surgeon at the A.I. duPont Hospital for Children.
Conflicts of Interest: Richard W. Kruse DO, MBA is a consultant for OrthoPediatrics.
Source of Funding: None
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Del Med J | September/October 2018 | Vol. 90 | No. 7
