Clinical efficacy analysis of Woodward's procedure for Sprengel deformity in children.

Objective: Sprengel deformity is a rare congenital anomaly of the shoulder that leads to cosmetic and functional impairment. This study aimed to evaluate the clinical efficacy of the Woodward procedure in children, with a focus on both functional and cosmetic outcomes. Methods: A retrospective analysis was conducted on 13 pediatric patients with unilateral Sprengel deformity who underwent the Woodward procedure. The average follow-up was 3.9 years (range,1-12 years). Preoperative and postoperative assessments were performed using the Cavendish grading and Rigault classification systems. Shoulder abduction angles were measured, and associated anomalies were documented. Intraoperative "wake-up" test was performed to confirm brachial plexus integrity for severe cases. Results: The mean preoperative shoulder abduction was 114.2°. Postoperatively, significant improvements were observed in both cosmetic and functional outcomes. According to the Cavendish classification, 92.3% of patients achieved an excellent cosmetic result (grade 1). The Rigault classification showed 92.3% of patients improved to grade 1. The mean improvement was 2.1 grades for Cavendish and 1.5 grades for Rigault. For superior displacement, the mean value decreased substantially from 32.68 mm preoperatively to 11.33 mm postoperatively. Similarly, the mean rotational angle was reduced from 23.35° to 6.43° after surgery. Partial regeneration of the superior scapular angle was identified in two cases, with a residual omovertebral bone present in one. Complications were minimal, with no brachial plexus injuries or reoperations reported. Conclusion: The Woodward procedure proves to be a safe and effective surgical intervention for Sprengel deformity, providing significant and sustained improvements in both cosmetic appearance and shoulder function in pediatric patients.