Medium to Long-Term Outcome of Thoracoscapular Arthrodesis with Screw Fixation for Facioscapulohumeral Muscular Dystrophy

• Published in: Journal of bone and joint surgery. American volume 2013-08, Vol.95 (15), p.1404-1408
• Main Authors: Van Tongel, Alexander, Atoun, Ehud, Narvani, Ali, Sforza, Giuseppe, Copeland, Stephen, Levy, Ofer
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arthrodesis; Bone Screws; Bone Transplantation; Female; Humans; Male; Middle Aged; Muscular Dystrophy, Facioscapulohumeral - physiopathology; Muscular Dystrophy, Facioscapulohumeral - surgery; Recovery of Function; Scapula - surgery; Shoulder Joint - physiopathology; Thoracic Wall - surgery; Treatment Outcome; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.L.01097

BACKGROUND:Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique). METHODS:All patients with facioscapulohumeral dystrophy who underwent thoracoscapular arthrodesis with screw fixation and bone-grafting from July 1997 to July 2010 were retrospectively reviewed. Preoperative and postoperative clinical assessment included active shoulder elevation, the Constant score, a patient satisfaction score, and cosmetic satisfaction. Union was determined both clinically and radiographically. RESULTS:Thoracoscapular arthrodesis was performed in thirty-five shoulders in twenty-four patients; eleven patients underwent bilateral procedures. The principal study group consisted of thirty-two shoulders in twenty-one patients with a minimum follow-up of twenty-four months (mean, eighty-eight months; range, twenty-four to 174 months). The mean Constant score increased from 30 (range, 17 to 41) preoperatively to 61 (range, 30 to 90) postoperatively. The mean satisfaction score increased from 1 (range, 0 to 4) to 8.4 (range, 4 to 10). Early complications consisted of one pneumothorax, one superficial wound infection, and four early failures, two of which were associated with noncompliance with the postoperative regimen. Late complications consisted of one posttraumatic fracture resulting in loosening and one painful nonunion; both were treated successfully with revision. CONCLUSIONS:Thoracoscapular arthrodesis with screw fixation prevented scapular winging and improved short-term and long-term shoulder function in patients with facioscapulohumeral dystrophy. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.