The feasibility and results of an arthroscopic removal of humeral locking plates and glenohumeral arthrolysis after proximal humeral fractures

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2014-02, Vol.22 (2), p.456-461
• Main Authors: Maqdes, Ali, Levy, Bruno, Klouche, Shahnaz, Hardy, Philippe
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroscopy - methods; Bone Plates; Bone Screws; Device Removal - methods; Feasibility Studies; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fractures; Humans; Internal Fixators; Joint surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Necrosis; Orthopedics; Pain; Patients; Physical therapy; Retrospective Studies; Shoulder; Shoulder Fractures - surgery; Shoulder Joint - injuries; Shoulder Joint - surgery; Surgeons; Trauma; Treatment Outcome
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-013-2437-8

Purpose This study describes the use of standard shoulder arthroscopy techniques to remove a proximal humerus locking plate following proximal humerus fracture. The goal of this study was to assess the feasibility and results of this technique. Methods This was a retrospective non-comparative study. Inclusion criteria were fracture union when hardware was removed, significant residual glenohumeral stiffness after 6 months of physiotherapy, arthrogenic screw(s) and/or osteonecrosis (partial or complete) of the humeral head resulting in significant pain. Results Eleven patients were included in this study. Surgery was successful in all cases, and surgery lasted a mean of 105 ± 10.5 min. Patients’ mean age was 54.6 ± 10.6 years and the mean hospital stay 1.6 ± 0.8 days. No patient was lost to follow-up. At the mean last follow-up of 17.7 ± 23.4 months, pain and all functional parameters improved significantly: the Constant score (43.4 ± 8.8 vs 60.5 ± 0.3, p  = 0.003), the visual analogue pain score (4.7 ± 1.5 vs 2.8 ± 2.3, p  = 0.012), the shoulder abduction (77.7 ± 18.6 vs 104.5 ± 27.3, p  = 0.004), the flexion (85.9 ± 30.7 vs 97.7 ± 27.7, p  = 0.026) and the external rotation (15 ± 12 vs 31.8 ± 13.6, p  = 0.004). Internal rotation improved from L3 to T12. All seven patients who practiced sports before the initial fracture had returned to sports approximately 6 months postoperatively. No infections or wound dehiscence occurred. Conclusion Shoulder arthroscopy was found to be feasible for removal of hardware following proximal humeral fracture and can be associated with diagnostic and therapeutic arthroscopy and glenohumeral arthrolysis if required. Level of evidence Case series with no comparison group, Level IV.