Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years

• Published in: European journal of orthopaedic surgery & traumatology Vol. 27; no. 3; pp. 317 - 321
• Main Authors: Maroun, Ch, Aliani, D., Hass, A., Werthel, J. D., Vidil, Anne, Valenti, Ph
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.04.2017; Springer Nature B.V
• Subjects: Adult; Aged; Arthroscopy; Bone Nails - adverse effects; Bone Plates - adverse effects; Device Removal; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Humans; Joint Diseases - etiology; Joint Diseases - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article • SHOULDER - FRACTURES; Patient Satisfaction; Radiography; Range of motion; Range of Motion, Articular; Retrospective Studies; Shoulder Fractures - complications; Shoulder Fractures - physiopathology; Shoulder Fractures - surgery; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Shoulder Pain - diagnostic imaging; Shoulder Pain - etiology; Shoulder Pain - surgery; Surgical Orthopedics; Tissue Adhesions - etiology; Tissue Adhesions - surgery; Traumatic Surgery; Young Adult; Shoulder arthroscopy; Removal of locking plate; Removal humeral intramedullary nail; Gleno-humeral arthrolysis
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-017-1938-4

Background Proximal humerus fractures are common injuries. Locking plates and anterograde medullary nails are the two most common fixation devices used when open reduction and internal fixation (ORIF) is indicated. Complications related to fracture and to hardware are numerous, especially shoulder stiffness. The goal of this study is to report the clinical outcomes of gleno-humeral arthroscopic arthrolysis combined with hardware removal. Methods A total of 58 patients (25 men, 33 women) with a mean age of 58 years (24–79) were reviewed retrospectively. Forty of them were active workers (5 heavy workers), and 18 were retired. A total of 24 fractures were reported after sport accident, 26 after domestic accident, and 8 after high energy trauma. Thirty-four patients with 3 or 4 part fractures (fracture through the anatomic neck and tuberosities), 20 patients with two part (displaced surgical neck) fracture and 4 cases of fracture of the tuberosities were operated. We combined a gleno-humeral arthrolysis by arthroscopy and a removal of the hardware using the previous incision for the plate or by arthroscopy for the nail. Results The average follow-up was 23 months (range 6–60). Pain in Constant Murley score (CS) increased from 7.3 ± 3.8 points preoperatively to 13 ± 2.76 points post-operatively ( p  < 0.05). CS increased from 36.8 ± 12.25 points to 68.45 ± 15.24 points. Subjective shoulder value (SSV) score increased from 45.8 ± 16.6 to 78.23 ± 14.74. A gain in all active range of motion was reported (forward flexion: 37.6°, abduction: 39.5°, external rotation: 24.3°, internal rotation: from L5-S1 to T12-L1). Conclusions Gleno-humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.