G D Harper1, S B Gunther1, D H Sonnabend2. 1. Consultant Orthopaedic Surgeon, QA Hospital, Cosham, PO6 3LY, Portsmouth, UK. 2. Department of Orthopaedics and Trauma, Prince of Wales Hospital, Sydney, Australien.
Abstract
OBJECTIVES: Stabilization of the glenohumeral joint to relieve pain and to improve function in instances of muscle paralysis secondary to plexus palsy, destruction of the joint with massive bone loss and large irreparable cuff tears. INDICATIONS: Paralysis of the rotator cuff or deltoid muscles secondary to brachial plexus lesions or polio. Severe joint degeneration following infection. Massive irreparable cuff tears. Failed arthroplasty. Severe rheumatoid disease. CONTRAINDICATIONS: Advanced arthritis of the ipsilateral elbow. Arthroplasty of the ipsilateral elbow. Extensive loss of scapulothoracic muscles. Severe thoracic scoliosis and advanced arthritis of the sternoclavicular and acromioclavicular joints are relative contraindications. SURGICAL TECHNIQUE: Anterolateral lazy S-incision. Retraction of deltoid. Osteotomy of the lateral acromion. Exposure and denuding of humeral and glenoid articular surfaces. Freshening of the undersurface of the acromion. Internal fixation with an 8- to 10-hole pelvic reconstruction plate in a position of 20 to 40° of abduction, 20 to 40° of flexion and 30 to 50° of internal rotation. Apposition of acromion. Postoperative immobilization for a period of at least 6 weeks on a splint prepared before surgery. This splint allows early mobilization of the elbow. RESULTS: Report on 60 shoulder arthrodeses (42 men, 18 women, average age 28 years, average length of follow-up 4 years). Plate loosening was observed 5 times, leading to a nonunion in 2 patients. A fracture beneath the plate occurred twice, in 5 patients the pain relief was not satisfactory. Revision became necessary in 2 patients due to poor position of the transglenoid screw. The time to union calculated in 49 patients amounted to an average of 7.9 months, in general union took longer following a failed arthroplasty and was shortest after brachial plexus palsy.
OBJECTIVES: Stabilization of the glenohumeral joint to relieve pain and to improve function in instances of muscle paralysis secondary to plexus palsy, destruction of the joint with massive bone loss and large irreparable cuff tears. INDICATIONS: Paralysis of the rotator cuff or deltoid muscles secondary to brachial plexus lesions or polio. Severe joint degeneration following infection. Massive irreparable cuff tears. Failed arthroplasty. Severe rheumatoid disease. CONTRAINDICATIONS: Advanced arthritis of the ipsilateral elbow. Arthroplasty of the ipsilateral elbow. Extensive loss of scapulothoracic muscles. Severe thoracic scoliosis and advanced arthritis of the sternoclavicular and acromioclavicular joints are relative contraindications. SURGICAL TECHNIQUE: Anterolateral lazy S-incision. Retraction of deltoid. Osteotomy of the lateral acromion. Exposure and denuding of humeral and glenoid articular surfaces. Freshening of the undersurface of the acromion. Internal fixation with an 8- to 10-hole pelvic reconstruction plate in a position of 20 to 40° of abduction, 20 to 40° of flexion and 30 to 50° of internal rotation. Apposition of acromion. Postoperative immobilization for a period of at least 6 weeks on a splint prepared before surgery. This splint allows early mobilization of the elbow. RESULTS: Report on 60 shoulder arthrodeses (42 men, 18 women, average age 28 years, average length of follow-up 4 years). Plate loosening was observed 5 times, leading to a nonunion in 2 patients. A fracture beneath the plate occurred twice, in 5 patients the pain relief was not satisfactory. Revision became necessary in 2 patients due to poor position of the transglenoid screw. The time to union calculated in 49 patients amounted to an average of 7.9 months, in general union took longer following a failed arthroplasty and was shortest after brachial plexus palsy.