Principles of Orthopaedic Correction

Correction of deformities in the area of the upper extremities can be functionally improving, palliative or only cosmetically indicated. Cerebral palsy rarely requires shoulder surgery, while correction of progressive flexion contractures is sometimes required at the elbow. For hand function improvements can be achieved by muscle lengthenings or arthrodesis. Conservative treatment is preferred in the management of patients with AMC. Good surgical indications are an external rotation osteotomy of the humerus to correct internal rotation contractures of the shoulder, a release of an extension contracture of the elbow and a V-osteotomy of the wrist. Surgical procedures to maintain congruency of the shoulder joint can be indicated early. If the shoulder joint is incongruent, an external rotational osteotomy can be useful, possibly in combination with a correction of a flexion contracture of the elbow. Severe pronation or supination malpositions of the forearm can be successfully corrected by osteotomies.