Die Arthrodese des Glenohumeralgelenks mit einer 4,5-mm-Rekonstruktionsplatte

Objective Arthrodesis of the glenohumeral joint while preserving scapulothoracic motion; elimination of pain. Indications Brachial plexus lesions with preserved function of elbow and hand. Paralysis of deltoid and rotator cuff after poliomyelitis. Neurogenic arthropathy. Infectious arthritis resistant to therapy. Severe, painful glenohumeral arthritis resistant to conservative therapy. Unsuccessful attempts to treat glenohumeral instability. Infected, painful loosened total shoulder replacement. Rotator cuff tears beyond repair. Contraindications Complete upper and lower plexus paralysis (no elbow and hand function). Incomplete recovery after neurosurgical interventions at the upper plexus (nerve transplantation, neurolysis). Insufficient strength of the scapular muscles. Inadequate soft tissue coverage at planned site of plate such as after burns, excessive previous surgery and radiotherapy. Surgical Technique Arthrodesis of the glenohumeral joint in 20° of abduction, 30° of flexion, and 40° of internal rotation using transarticular lag screws. To compensate for moments of tension that are generated by the weight of the arm and that act on the site of arthrodesis, a 4.5-mm pelvic reconstruction plate is inserted from the scapular spine to the anterolateral humeral shaft, thus acting as a tension band while at the same time increasing the interfragmentary compression. Results Between 1994 and 1998, a glenohumeral arthrodesis with a reconstruction plate was performed in 14 patients (twelve men, two women, average age 35.4 [17–56] years). After an average of 14 months postoperatively, active abduction had improved from 10° to 59° and flexion from 11° to 51°. Three patients considered their result excellent (21.4%), eight (57.1%) good, two (14.3%) fair, and one poor (7.1%).