Shoulder arthrodesis with plate fixation

Objective: The aim of this study was to evaluate the long-term outcome of shoulder arthrodesis with plate fixation and primary autogenous grafting in terms of pain, functional status and arthrodesis position. Methods: The study included 8 patients (7 males and 1 female; mean age: 39.3 years; range: 22 to 68 years) who underwent arthrodesis with plate fixation and primary autogenous grafting. Mean follow-up period was 66.6 (range: 47 to 96) months. Five cases had traumatic brachial plexus palsy, 2 polio sequela and 1 sequela of an operated proximal humerus fracture due to a falling injury. One of the traumatic palsy cases was accompanied with a humerus shaft fracture. Arthrodesis was performed in all cases according to AO principles with plate fixation and primary autogenous grafting. Five of the paralytic patients also underwent Steindler flexorplasty. Follow-up assessments included monthly radiologic control for union, the visual analog scale (VAS) for pain and the Oxford shoulder score (OSS) for functional status. Results: Radiological fusion was seen in all cases in an average of 16 (range: 12 to 18) weeks, and arthrodesis was stable at physical examination. The accompanying humerus shaft fracture was also fixed with plate. One patient with traumatic palsy experienced a humerus fracture distal to the arthrodesis plate at the 8th postoperative month. An additional traumatic palsy case had flexion deformity at the wrist in the second year of follow-up and a wrist arthrodesis with dorsal plate was performed. One patient (12.5%) had a donor site infection on the tenth day after surgery. The target positions of 30° of abduction, 30° of forward flexion, and 30° of internal rotation were achieved with an average deviation of 7°. Mean active abduction was 68.1° (range: 55° to 90°), flexion was 67.5° (range: 60° to 85°), and internal rotation was at the level of trochanter major. The mean OSS was 35.9 (range: 32 to 40), and the mean VAS score was 2.9 (range: 1 to 7). Conclusion: Our findings show that AO reconstruction plate and primary autogenous bone grafting is a safe and effective arthrodesis method that can also be used as a salvage procedure.