arthrodesis of shoulder

indications

· alternative when arthroplasty contraindicated

· young active patients

· excessive bone loss

· salvage procedure for failed arthroplasty

· active or recent infection

· loss of function of both deltoid and rotator cuff

· neuromuscular

· brachial plexus

· after tumour resection

Advantages

· permanent solution

Disadvantages

· loss of movement at shoulder

· perineal care

· feeding

· loss of movement at other joints

· because of prolonged immobilisation

technique

Position

· aim for

· 20^o abduction

· 30^o flexion

· 40^o internal rotation

· should achieve ability to reach mouth

· technically difficult to obtain correct position intraoperatively

· should ensure intraoperatively that flexion of elbow allows tip of thumb to strike chin

Options

· intra-articular

· extra-articular

· combined

AO method

· lateral decubitus position

· make incision over

· spine of scapula

· acromion

· proximal third of humerus

· strip deltoid and rotator cuff and expose

· spine of scapula

· glenoid fossa

· proximal humerus

· denude glenoid fossa and humeral head

· decorticate undersurface of acromion and lateral part of humerus

· displace humeral head superiorly and medially

· to contact denuded glenoid and acromion

· position humeral head in desired position

· can temporarily fix position and obtain radiographs to compare with pre-operative radiographs in desired position

· apply first standard broad AO plate

· superiorly along scapular spine, acromion and proximal third of humerus

· apply second plate

· posteriorly from scapular spine to humerus

· apply bone graft

· airplane splint postoperatively