Search

Complications after shoulder arthrodesis are frequent. Through results and comparisons with the literature, the presented article analyzes the correlation of complications with the specific operative techniques, indications, and postoperative treatment. Between 1964 and 2001, a total of 43 cases of shoulder arthrodesis (13 screw and 30 plate arthrodeses) were performed and then analyzed after a mean of 6.7 years (range, 0.5-36 years). Surgery was carried out on 10 female patients (23%) and 33 male patients (77%) with a mean age of 35 years (range, 11-82 years). These patients had the following indications: paralysis (32 [74%]), osteoarthritis or humeral head necrosis (15 [35%]), infection (7 [16%]), and persistent shoulder instability (6 [14%]). The extent of active movement after arthrodesis was 56 degrees abduction (range, 20 degrees - 90 degrees) and 60 degrees forward flexion (range, 20 degrees - 105 degrees), with an increase in the Constant score in all cases, from a mean of 27 points preoperatively to 57 points postoperatively (difference, 30 points). The patients rated the outcome of surgery as excellent, good, or satisfactory in 91% of cases. Complications after shoulder arthrodesis were noted in 12 of 43 patients (28%). The most frequent complications after screw/plate arthrodesis included pseudarthrosis, 2 (15%)/3 (10%); infection, 1 (8%)/4 (13%); and fracture of the humerus, 0/4 (13%). No specific judgment can be attributed to the different osteosynthesis techniques used in shoulder arthrodesis, either in the cases presented at our clinic or in the literature. Pseudarthrosis appeared to be less frequent in cases of plate arthrodesis compared with screw arthrodesis. However, the application of plates resulted more often in infection, postoperative fractures of the humerus, and the necessity for removal of material. Particularly in patients with paralysis, a shoulder arthrodesis resulted in an improvement in postoperative active function and presented a suitable operative option.

Arthrodesis of the hindfoot is indicated in congenital foot deformity of young adults, in posttraumatic arthrosis of the subtalar joint following calcaneus fractures, in idiopathic, isolated arthroses of hindfoot joints, in rheumatoid arthritis and in deformities of the longitudinal arch of the foot. Common and useful combinations are the triple-arthrodesis and the arthrodesis of the subtalar and the calcaneocuboid joint, in particular if both joints are affected by calcaneus fractures. Arthrodesis of the subtalar and the talonavicular joint are often performed as isolated procedures. The three-dimensional structure of the hindfoot articulations may impede perfect contact of the bone surfaces in combined arthrodeses. Various fixation methods are in use. Follow-up examination of 52 arthrodeses after 11.1 years revealed good, symptomatic improvement in most patients. However, complete bony union was achieved in only 47 percent, and this was due to insufficient stabilization of the arthrodesis in many cases. In view of comparable rates of pseudarthroses in the literature, we advocate stable internal fixation with screws or bone staples.