Septic Arthritis of the Shoulder with Proximal Humerus Osteomyelitis, Treated by Ilizarov Shoulder Arthrodesis.

John Kendall,Martin Mcnally

doi:10.7150/jbji.17083

Abstract

Septic arthritis of the shoulder can destroy the glenohumeral joint resulting in significant pain, instability and poor function. Surgical treatment is notoriously difficult with significant risk of complications. Shoulder arthrodesis has been performed using both internal and external fixation but has high complication rates in the presence of infection.We present our experience of managing a patient with significant pain and loss of function as a result of septic arthritis of the shoulder following infected proximal humeral fracture fixation with associated proximal humeral osteomyelitis. We discuss patient presentation, appropriate investigations, decision-making, pre-operative planning and the principles of managing of bone and joint infection.Wide excision with Ilizarov stabilisation and implantation of an absorbable antibiotic carrier, allowed successful fusion with eradication of the infection. The benefits of using this arthrodesis technique include reduced risk of infection recurrence and excellent stability of construct, therefore reducing time to fusion and minimising soft tissue trauma with the opportunity for early rehabilitation and return to optimal level of function.

Highlights

Septic arthritis of the shoulder can cause destruction of the glenohumeral joint resulting in significant pain, instability and a reduced level of function
Shoulder arthrodesis is reported in the literature as a surgical technique for managing a variety of conditions including trauma [2], osteoarthritis [3], brachial plexus injury, deltoid and rotator cuff paralysis, failed revision arthroplasty, severe refractory instability, bone deficiency following tumour resection in the proximal humerus [4, 5], as well as for infection [1, 5, 6, 11]
An article written in Czech by Král et al [11] reported a series of five patients treated with shoulder arthrodesis using external fixation for chronic inflammatory complications related to infection following proximal humeral fractures

Summary

Introduction

Septic arthritis of the shoulder can cause destruction of the glenohumeral joint resulting in significant pain, instability and a reduced level of function. An article written in Czech by Král et al [11] reported a series of five patients treated with shoulder arthrodesis using external fixation for chronic inflammatory complications related to infection following proximal humeral fractures.

Results

Conclusion