Arthrodesis Of A Flail Shoulder In Poliomyelitis

摘要

Fifteen patients with a mean age of 14.86 years ( 11 males and 4 females), suffering from flail shoulder secondary to poliomyelitis with good elbow and hand functions, and good power in serratus anterior and trapezius muscles were treated by shoulder arthrodesis in 400 to 600 of abduction, 200 to 300 of flexion, and 250 to 300 of internal rotation. 80% of the patients were satisfied with the procedure and were able to reach mouth, opposite axilla, side pocket, back pocket, and anal region. 80% were able to sleep on the fused side. Authors proposes that extra amount of abduction is required, so as to compensate for the weakness of elbow flexors in poliomyelitis Introduction Twenty first century is considered to be era of arthroplasty with emphasis on to provide painless, mobile and stable joint. Arthrodesis, especially shoulder arthrodesis appears to be procedure of the past. In western world, indications for shoulder arthrodesis have been narrowed down to complete brachial plexus lesions, deltoid muscle paralysis, massive rotator cuff deficiencies following multiple attempts at repair, multiple failed athroplasties, chronic infections, bone resections following tumor resection and chronic dislocations3. But in developing countries of Asia and Africa, where poliomyelitis is still prevalent and one usually come across patients with flail shoulder secondary to poliomyelitis. These patients usually have good elbow and hand functions and good seratus anterior and trapezius muscles are unable to optimize their upper extremity due to their inability to place their hand in space. Glenohumeral arthrodesis stabilizes the extremity and allows effective use of hand. Such patients can then fully utilizes their upper extremity potential and can work effectively at bench level.There is controversy regarding the position of arthrodesis, particularly abduction and method to measure it. Authors in their study, while presenting the results of shoulder arthrodesis, have tried to discuss different methods of evaluations and amount of abduction in shoulder arthrodesis. Material And Methods The study included 15 patients of extensive paralysis of shoulder secondary to poliomyelitis with fair to good elbow and hand functions and good trapezius and serratus anterior muscle power in time period from January 1991 to December 2000. The age of patients varied from 9 to 23 years (mean 14.86). Among them 11 were males and 4 females. Left side was affected in 70% and right side was affected in 30% of the patients. 80% were affected from poliomyelitis at the age of 1-3 years whereas 20% were affected at the age of 4-5 years. Special care was taken for the selection of the patients so as to exclude the patients suffering from paralysis of scapulo-thoracic muscles and without good elbow and hand functions.Supine position was used in all cases. Intra-articular arthrodesis was done using Steindler method with two to three 4 mm cancellous screws. Bone grafting was done in all cases. The joint was fused in clinical abduction of 40- 600, 20- 300 of flexion and 25-300 of internal rotation. All patients were given shoulder spica in post operative period till solid fusion. Antero–posterior skiagrams were taken immediately after the operation and thereafter at the interval of 4-6 weeks till fusion were evident on x-rays. After the removal of shoulder spica, vigorous supervised physiotherapy of the scapulo-thoracic muscles, elbow and hand was started. Results Results were analyzed in terms of1) Position of arthrodesis2) Functional assessment in terms of whether patients are able to reach mouth, opposite axilla, comb hair, side pocket, back pocket, perineal region, and zip or unzip their pant. 3) Ability to lower the arm by side of body without the prominence of scapula.Results are summarized in table number 1.