A Ghabi, B De Goefroy, Ph Candoni, C Andro, L Mathieu
(Marseille, Brest, Lyon)
Introduction
Scapulohumeral arthrodesis is generally described in tumor surgery, shoulder prosthesis failures, or brachial plexus surgery but very rarely in the context of war-related shoulder trauma. The sequelae of ballistic shoulder injuries can sometimes be so severe that they prevent any prosthetic reconstruction solutions. The septic risk being higher in war surgery, our objective was to describe a technique and the results of two-stage Masquelet scapulohumeral arthrodesis using a non-vascularized fibula graft. Our hypothesis was that this technique would allow for consolidation and satisfactory functional results with fewer complications.
Material and Method
Two patients underwent two-stage scapulohumeral arthrodesis fixed by plate with fibula graft and non-vascularized composite graft for sequelae of ballistic injuries of the proximal humerus with joint destruction, bone substance loss of ≥ 10 cm on the proximal humerus, rotator cuff and deltoid destruction, and brachial plexus involvement.
Results The average age was 32 years, the average size of the humeral bone substance loss was 12 cm, and the average time between trauma and the first stage of Masquelet arthrodesis was 9 months. They underwent an average of 5 surgeries before reconstruction. The average follow-up was 16 months. All patients had rotator cuff involvement and severe axillary nerve or brachial plexus damage. The mean postoperative Constant score was 46 at the last follow-up, and the mean QuickDASH was 45. Joint range of motion evolved as follows from preoperative to the last follow-up examination: flexion from 20 to 110 degrees, abduction from 10 to 85 degrees, external rotation from -35 to 10 degrees, and internal rotation from non-testable to hand-to-back. We had no complications, and both patients achieved consolidation.
Discussion
In the literature, the few series on the reconstruction of ballistic injury sequelae report poor results on consolidation during one-stage arthrodesis with allograft and a high infection rate for arthroplasties. Arthrodesis performed in more « classic » indications allows for satisfactory mobility restoration, and performing it in two stages according to Masquelet
increases the chances of consolidation in large bone substance losses and minimizes infection risks.
Conclusion
Two-stage scapulohumeral arthrodesis for ballistic injury sequelae with large bone substance loss and rotator cuff and deltoid involvement is a reconstruction solution that appears to offer the same reliability as that of long bone and lower limb reconstructions in these high-septic-risk contexts.