Letters to the Editor

Abstract

Reply to Sol and Plettenburg Dear Sir: Apart from some details, we do not agree with the criticism of Sol and Plettenburg. The aim of our clinical study was to investigate the impact of shoulder fusion on activities of daily living in patients with a completely flaccid arm. Our intent was not to give a description on how to fit the WILMER orthoses.1 Any hand function is not relevant to the case. The study was retrospective and descriptive. We are familiar with the proposed study designs but they were and are not feasible. The purpose of our study was not to evaluate the efficacy or the biomechanical attributes of the WILMER orthoses. Within the limited space available we gave a concise description. Sol and Plettenburg argue with clinical experience based on more then 200 patients, which we could not find in the literature. The indication for a shoulder fusion was not determined by availability of orthoses, but by the disadvantages of an a functional completely flaccid arm, swinging uncontrollably, as experienced by the patient. After the fusion we elected to use the WILMER elbow orthosis to fix the forearm in the desired position. Discussing the unstable elbow joint seems to be confusing. From a biomechanical point, the elbow might be stable, but from a functional point it is not. We agree with the comment on Table 1; the wrong table was submitted, so the link to Table 4 becomes less clear. Finally we cannot deny the benefits expressed by those patients who underwent a shoulder fusion and used the prescribed orthoses. C.H. Emmelot, MD, PhD H.K.L. Nielsen, MD, PhD W.H. Eisma, MD Zwolle, The Netherlands