Shoulder Arthrodesis versus Upper Trapezius Transfer for Traumatic Brachial Plexus Injury: A Proportional Meta-Analysis

Shoulder arthrodesis and upper trapezius transfer are two surgical options for secondary shoulder reconstruction for traumatic brachial plexus injury (BPI). There is a lack of comparative evidence to guide the choice for one procedure over the other. The objectives of this study were to compare (1) rates of complications and reoperation and (2) shoulder range of motion and functional outcome scores following shoulder arthrodesis versus upper trapezius transfer for traumatic BPI. A systematic review and meta-analysis were conducted by a search of four databases of studies assessing shoulder arthrodesis and/or upper trapezius transfer for shoulder reconstruction following adult traumatic BPI. A proportional meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The final meta-analysis included 374 patients from 17 studies, including 232 patients from 11 studies on shoulder arthrodesis and 142 patients from 6 studies on upper trapezius transfer. Shoulder arthrodesis had higher rates of complications and reoperations than upper trapezius transfer for traumatic BPI, but these differences did not reach a statistical significance. Due to the limited sample size, variations in reporting, and study heterogeneity in the published literature, we were not able to draw conclusions regarding shoulder range of motion and functional outcome scores between these two procedures. Shoulder arthrodesis and upper trapezius transfer are both viable options for secondary shoulder reconstruction for traumatic BPI, but with different complications and reoperation profiles. Patients should be counseled on the risk of nonunion and humerus fracture following shoulder arthrodesis.

The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis

Based on the literature, 294 shoulder arthrodeses after brachial plexus injury in adults were assessed, mostly male; the mean age of the patients was 33 years, and the mean follow-up time was 5.5 years. The most common cause of injury was a traffic accident, especially on a motorcycle. Arthrodesis position ranged from 15 to 40 degrees of flexion, 15 to 60 degrees of abduction, and 0 to 50 degrees of internal rotation with the predominance of position by the 30-30-30 rule. Plates, screws, and external fixation were used for stabilization. The complication rate was at the level of 28%, the most common complication being delayed union or nonunion. Active movements of flexion and abduction averaged 61 and 56 degrees, respectively, while reaching the hand to the mouth, front pocket, and buttock was feasible for 69%, 71%, and 38%, respectively, after surgery. Shoulder pain was present in 77% of patients, and 28% experienced no relevant pain reduction after surgery. The subjective satisfaction rate was 82% based on significant improvement and satisfaction reported by patients after arthrodesis. Arthrodesis of the shoulder, in adult patients after brachial plexus palsy, can reduce shoulder pain, increase stability, and result in a range of motion that increases the possibility of carrying out everyday activities. This affects the high level of subjective patient satisfaction after surgery. Cite this article: EFORT Open Rev 2021;6:797-807. DOI: 10.1302/2058-5241.6.200114

Glenohumeral Arthrodesis Using Pelvic Reconstruction Plates: a Series of 15 Patients

Background. Glenohumeral joint arthrodesis has become a rare entity due to the introduction of shoulder arthroplasty. It is an excellent salvage procedure for patients with severe shoulder dysfunction, with limited treatment options, indicated for brachial plexus injury, tumour resection, chronic infection, failed prosthetic arthroplasty, or pseudoparalysis of the shoulder due to combined rotator cuff and deltoid deficiency. Shoulder arthrodesis relieves the patient of pain and gives a decent amount of function. The aim of this study was to examine the mid-term outcomes of glenohumeral arthrodesis with 2 pelvic recon plates. Methods and methods. This study was done in a tertiary referral centre over a period of about 2 years. All the patients were operated on with 2AO 3.5mm recon plates and screws. Indications for surgery comprised unreconstructable rotator cuff tears, a neoplastic lesion, paralytic disorders, TB shoulder, arthritic disease unsuitable for arthroplasty, and sequelae of septic shoulder. Cancellous grafts were used in all operated patients, while a cortical graft was used in the tumour case to fill the bone defect after tumour excision. A minimum of 18 months was essential for inclusion into the study. Results. 15 patients were included in the study. All the patients had decreased postoperative pain, which further decreased to pain-free status at further follow-up visits. All the arthrodeses produced bony union with average time to union of 5.4 months. All patients could feed and dress themselves with the ipsilateral limb. The only complication noted in this series was a superficial infection in 3 patients only, which subsided after wound wash, debridement and antibiotics for 10 days. Conclusions. 1. With specific indications, shoulder arthrodesis results in a good painless postoperative shoulder function and thus presents an excellent operative option. 2. The position of arthrodesis chosen here ensures that the arm rests comfortably at the side. 3. The patients can move their hands to their mouth and facial regions. 4. Recon plates should be used for arthrodesis because they are easy to shape without compromising on strength. 5. Few complications of procedure are there but it is a great therapeutic measure in selected individuals.

Shoulder Arthrodesis for Traumatic Brachial Plexus Injuries: Functional Outcomes and Complications

Background The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure. Methods Between 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. The main indication for arthrodesis was absent or poor recovery of shoulder abduction and external rotation. Patients presented different levels of injury. Shoulder measurements of active abduction and external rotation were made based on image records of the patients. A long 4.5-mm reconstruction plate was fit along the scapular spine, acromion, and lateral proximal third of the humerus. Structured bone graft was fit into the subacromial space. Results The mean preoperative abduction was 16°, and the mean postoperative abduction was 42°. The mean preoperative external rotation was −59°, and the mean postoperative external rotation was −13°. The mean increase in abduction and external rotation was 25° and 45°, respectively. Bone union was achieved in all cases at an average time of 5.23 months. We experienced humeral fractures in 26.66% of the cases, which were all successfully treated nonoperatively. Conclusions Shoulder arthrodesis is a rewarding procedure for patients with brachial plexus injuries. A marked improvement in the upper limb positioning was observed in all patients. It should be considered as the main therapeutic option in cases where nerve reconstruction is no longer possible.