[Screw arthrodesis of the shoulder].

OBJECTIVE

The aim of the procedure is arthrodesis of the shoulder by osteosynthesis of the glenohumeral and the acromiohumeral joint each with three screws, which results in preservation of scapulothoracic motion and pain relief.

INDICATIONS

Traumatic brachial plexus lesions, palsy in infancy, poliomyelitis with preserved or restorable function of the elbow and the hand. Paralysis of the deltoid muscle and the rotator cuff. Nonrestorable vast defect of the rotator cuff with pseudoparalysis. Chronic infectious arthritis resistant to therapy. Unsuccessful attempts to treat glenohumeral instability. Alternative procedure to shoulder arthroplasty in young patients with omarthrosis, who perform hard physical work.

CONTRAINDICATIONS

Insufficient strength of the scapular muscles (< grade 4, <75% of normal strength). Insufficient scapulothoracic passive motion. Inadequate soft tissue coverage after burns, excessive previous surgery or radiotherapy. Incomplete rehabilitation (<3 years) after neurosurgical interventions (neurolysis, nerve transplantation). Cases of resection of the proximal humerus.

SURGICAL TECHNIQUE

Acampsia of the shoulder joint in 20° of abduction, 30° of anteversion, and 40° of internal rotation using three glenohumeral and three acromiohumeral spongiosa screws as a compression arthrodesis.

POSTOPERATIVE MANAGEMENT

Thorax-arm-abduction splint (20° of abduction, 30° of anteversion, and 40° of internal rotation) until the week 6 postoperatively with removal for physiotherapy and personal hygiene. Assisted active and passive motion exercises for the elbow, hand, and fingers after the postoperative day 1. Weaning from the splint after the end of the week 6 postoperatively, full range of motion allowed.

RESULTS

In a prospective study from January 2007 to September 2008, 4 patients with a medium age of 35.7 years underwent screw arthrodesis of the shoulder with a follow-up of 1.0 (0.6-1.5) year. Primary fusion of all arthrodesis surfaces was achieved in all patients; no revision surgery was necessary. All patients improved in shoulder function with an average range of motion of 60° abduction and 40° anteversion.