Journal of Pediatric Orthopaedics - 2026-09-15 - Journal Article
Surgical Outcome of Modified Woodward Procedure in Congenital Undescended Scapula.
Shahcheraghi GH, Javid M, Farsimadan M
Topics
Key Takeaway
Modified Woodward procedure with clavicle morcellation improved Cavendish grade in 25/27 shoulders and yielded mean shoulder abduction gains of 34° and forward flexion gains of 39° at mean 8.1-year follow-up.
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Summary
This retrospective series evaluated the modified Woodward procedure with clavicle morcellation for Sprengel deformity in 25 patients over a 26-year period, using Cavendish/Rigault classifications, Oxford Shoulder Score, and radiographic GIA and ISA measurements. Cavendish grade improved in 25/27 shoulders (1–3 grades), mean OSS was 42.5/48, and abduction and forward flexion improved by 34° and 39° respectively (P=0.001). Surgery after age 8 and concurrent congenital scoliosis did not adversely affect shoulder outcomes; simultaneous convex-side posterior spinal fusion halted curve progression in 4/4 cases versus mean 12° progression in the 11/12 unfused cases.
Key Limitation
The 26-year study span introduces significant surgeon experience bias and likely technique heterogeneity, making it impossible to isolate the contribution of any single technical modification to outcomes.
Original Abstract
BACKGROUND
Sprengel deformity is a rare congenital anomaly of the shoulder girdle characterized by an elevated and malrotated hypoplastic scapula, resulting in cosmetic disfigurement and functional limitation. Surgical procedures aim to improve shoulder function and appearance.
METHODS
We reviewed Sprengel deformity (SD) treated with the modified Woodward procedure and clavicle morcellation between 1998 and 2024, and clinically and radiographically evaluated patients using the Cavendish and Rigault classifications. We also documented shoulder range of motion and assessed function using the Oxford Shoulder Score (OSS). The preoperative Glenoid Inclination Angle (GIA) and Inferior Scapular Angle (ISA) were compared with the postoperative values. We statistically analyzed the results separately for surgeries performed before and after 8 years of age.
RESULTS
Twenty-seven shoulders in 25 patients with a mean age at surgery of 7.6±4.4 years and a mean follow-up of 8.1±6.1 years were examined. Cavendish grading improved in 25 shoulders by 1 to 3 grades, and Rigault grading improved in 24 shoulders by 1 to 2 grades. The mean OSS was 42.5/48. Improvements in shoulder abduction of 34±17 degrees and forward flexion of 39±25 degrees (P=0.001) were observed. GIA and ISA demonstrated improvement in scapular position and glenoid orientation. Nine patients had minimal residual limitations in some overhead activities and dressing tasks. Sixteen shoulders had associated congenital scoliosis on the same side as the SD. Simultaneous posterior spinal fusion in 4 of 16 congenital scoliosis cases halted curve progression, while 11 of 12 remaining cases showed a mean curve progression of 12±16 degrees. The presence of congenital scoliosis or surgery after 8 years of age did not adversely affect surgical outcomes. Observed complications included one transient brachial plexus palsy and one clavicle nonunion.
CONCLUSION
Surgery for SD using the modified Woodward procedure and clavicle morcellation resulted in significant improvements in shoulder motion and high patient satisfaction, with favorable patient-derived outcomes. Radiographic GIA and ISA measurements complement surgical outcome assessment. This surgery is also effective in older children and in the presence of congenital scoliosis and chest cage anomalies. Simultaneous convex-side posterior vertebral fusion would halt the progression of the scoliosis curve in younger children.
LEVEL OF EVIDENCE
Level IV.