Outcomes of Mini-Invasive Arthroscopic Arthrolysis Combined with Locking Screw and/or Intramedullary Nail Extraction after Osteosynthesis of the Proximal Humerus Fracture.

Roman Madeja,Jana Pometlová,Adéla Vrtková,Jan Stránský,Leopold Pleva,Jaroslav Janošek,Kristýna Čabanová,Roman Brzóska,Lubor Bialy,Jiří Voves

doi:10.3390/jcm11020362

Abstract

Data on the effectiveness of arthroscopic arthrolysis and extraction of osteosynthetic material after osteosynthesis of the proximal humerus in patients with persisting problems are rare and insufficient. In this study, we performed arthroscopic arthrolysis and extraction of fixation screws, and, where protruding, extraction of the nail in 34 patients with problems persisting 12 months after osteosynthesis of the proximal humerus using an intramedullary nail. The effectiveness of the treatment was assessed using the Constant–Murley shoulder score and forward flexion difference between the treated arm and the contralateral one. A median increase of 16 points in CMS score and 30 degrees reduction in the arm forward flexion difference was recorded 12 months after the arthroscopy. The improvement was significantly higher in the patient group with intramedullary nail extraction (however, this group had worse pre-operative values and the screw was only extracted where likely to cause problems). The median time to heal was 11 weeks; no serious peri- or post-procedural complications occurred. Mini-invasive arthroscopic arthrolysis combined with extraction of osteosynthetic material proved to be a safe and effective method for treatment of patients after osteosynthesis of the proximal humerus using an intramedullary nail with persisting pain and/or mobility limitation.

Highlights

The development of modern implants ensuring stable osteosynthesis of the proximal end of the humerus facilitating early rehabilitation has led to an increase in the number of such osteosyntheses [1]
It is necessary to emphasize that the presented study does not analyze or discuss the methods and outcomes of primary osteosynthesis but only outcomes of a follow-up arthroscopic arthrolysis with extraction of the osteosynthetic material
12 months after the arthroscopic procedure in all studied parameters including all individual components of the Constant–Murley score (CMS) score

Summary

Introduction

The development of modern implants ensuring stable osteosynthesis of the proximal end of the humerus facilitating early rehabilitation has led to an increase in the number of such osteosyntheses [1]. This approach led to an improvement of the outcomes in the treatment of such fractures and improvements in further joint functionality. Are used to a lesser extent [2] Each of such methods has its pros and cons and are better suited for certain types of injuries; in a recent systematic review and meta-analysis, osteosynthesis by intramedullary nail has been shown to be superior to that by locking plate [3]. The likely cause is that the new open surgery represents new major stress, and, despite possible redress, new adhesions can form during wound healing

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Conclusion