Two-stage glenohumeral fusion for the paralytic shoulder

Shoulder fusion after nerve injury can improve overall arm function; however, high revision and low patient satisfaction rates have been described. The purpose of this study is to describe a 2-stage shoulder fusion, first pinning in a position of function and then converting to a shoulder fusion. Ou...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2024-11
Main Authors: Lohre, Ryan, Omurzakov, Argen, Navarro, Michael B., Dua, Karan, Ahmed, Abdulaziz F., Elhassan, Bassem
Format: Article
Language:English
Subjects:
Brachial plexus injury
glenohumeral fusion
nerve injury
percutaneous pinning
shoulder fusion
two-stage glenohumeral fusion
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Summary:Shoulder fusion after nerve injury can improve overall arm function; however, high revision and low patient satisfaction rates have been described. The purpose of this study is to describe a 2-stage shoulder fusion, first pinning in a position of function and then converting to a shoulder fusion. Our hypothesis is that temporary pinning improves overall satisfaction after shoulder fusion in comparison to satisfaction reported in the literature. A retrospective review was performed for patients receiving 2-stage shoulder fusion between 2020 and 2023. Patient demographics and clinical outcomes were recorded. Univariate statistics were performed to compare pre- and postoperative values. Eighteen patients with an average age of 47 ± 17.3 years and average follow-up of 23.7 ± 4.5 months were included. Preoperative diagnoses included brachial plexus injury (n = 13; 72%), late presentation obstetric brachial plexus injury (n = 2; 11%), traumatic brain injury (n = 1; 14.2%), cervical spinal cord injury (n = 1; 14.2%) and iatrogenic axillary nerve injury with advanced arthritis (n = 1; 14.2%). Twelve (67%) patients received unilateral shoulder fusion 2.7 ± 1.9 days after their initial pinning. Six patients (28.6%) did not receive a second stage fusion. Reasons for not continuing with fusion were attributed to perceived hand function and arm position. Three patients received 2 shoulder pinnings prior to their fusion to adjust the fusion position to accommodate more internal rotation. After fusion, both Subjective Shoulder Value (5.2 ± 5.5% vs. 71.6 ± 10.4%; P 
ISSN:1058-2746
1532-6500
1532-6500
DOI:10.1016/j.jse.2024.09.013