Maqdes A, Levy B, Klouche S, Hardy P: The feasibility and results of an arthroscopic removal of humeral locking plates and glenohumeral arthrolysis after proximal humeral fractures. Knee Surg Sports Traumatol Arthrosc 2013 Feb 9. [Epub ahead of print] Doi 10.1007/s00167-013-2437-8

Abstract

It is with great interest that we read the paper by Maqdes et al. [3] regarding ‘‘the feasibility and results of an arthroscopic removal of locking plates and glenohumeral arthrolysis after proximal humeral fractures’’, published in Knee Surgery Sports Traumatology Arthroscopy online first in February 2013. Six months after the surgical treatment as described before, the results of eleven patients were evaluated. The authors concluded that the technique is very beneficial, feasible for shoulder surgeons, and that it should become the standard technique for patients with indication for the implant removal of locking plates after proximal humeral fractures [3]. Our study group published the technique of ‘‘Arthroscopic locking plate removal after proximal humeral fractures’’ in April 2009 already [4]. In November 2009, Dines et al. [1] published ‘‘Arthroscopic removal of proximal humeral locking plates’’ in the journal Knee Surgery Sports Traumatology Arthroscopy. We agree with the findings of Dines et al. and Maqdes et al. [1, 3] regarding the technique and the feasibility of arthroscopic locking plate removal of proximal humeral fractures. Several surgeons have benefitted from 4 years experience in applying this technique to more than fifty patients and share the opinion that an arthroscopy is mandatory in the context of hardware removal after locked plating of proximal humeral fractures [2]. In their paper, Maqdes et al. [3] state that to their ‘‘...knowledge, there are no studies in the literature that have reviewed the results of combined arthroscopic proximal humeral plate removal and glenohumeral arthrolysis’’ and that ‘‘...although none of these authors statistically evaluated their results, they all agree on the benefits of arthroscopically assisted or all-arthroscopic removal of material’’. In May 2011, our study group published prospective results online, comparing the results of twenty patients with arthroscopic implant removal to those of nine patients with open hardware removal with a median 9.5 months after locked plating of proximal humeral fractures [2]. Despite being written in German, an English abstract is listed in ‘‘PubMed’’. Using the searching terms ‘‘arthroscopic implant removal’’, ‘‘implant removal proximal humerus’’, ‘‘arthroscopy proximal humerus’’ or ‘‘arthroscopy proximal humeral fracture’’, the paper can easily be found, as can the publications concerning the technique of arthroscopic implant removal that were cited by Maqdes et al. [3]. Had the corresponding author been contacted, information regarding the results would have been provided with pleasure. We understand the paper might have simply been missed in a literature search, for example due to an English language filter, we would hence like to take the opportunity to briefly outline our findings in addition to the information provided in the English abstract of the paper [2]. The ageand gender-related Constant Score of the arthroscopically treated group was 76.3 ± 21.9 % compared to 79.5 ± 17.5 % in the openly treated group; no significant difference was found between the two groups (n.s.). All arthroscopically treated patients (n = 20) had a subacromial arthrolysis, in thirteen patients (65 %) the limited range of motion made an intraarticular arthrolysis with partial or complete 360 -capsulotomy necessary. In 85 % (n = 17), concomitant intraarticular pathologies of This comment refers to the article available at doi:10.1007/s00167013-2437-8.