Selective Glenohumeral external rotation deficit – sequelae of post-ORIF deltoid adhesions after treatment of the proximal humerus fracture

BMC Musculoskeletal Disorders

Michał Waszczykowski¹  Jarosław Fabiś² 

[1] Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, Medical University of Lodz, Lodz, Poland, ul. Żeromskiego 113, 90-549, Lodz, Poland;Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, Medical University of Lodz, Lodz, Poland, ul. Żeromskiego 113, 90-549, Lodz, Poland;FMC Medical Center, 9A Piłsudskiego, Lodz, Poland;

关键词: Proximal humerus fracture;    Arthroscopic plate removal;    Selective glenohumeral external rotation deficit;    Deltoid adhesion;    Deltohumeral space;   

DOI  :  10.1186/s12891-020-03634-2

来源: Springer

【 摘 要 】

BackgroundThe deltopectoral approach is commonly used for plate stabilization of proximal humerus fracture. Although adhesions between the deltoid, plate, and humerus are common sequelae of plate ORIF, little is known about their effect on the range of movement and a function of the shoulder. To confirm their impact, the preoperative and intraoperative evaluation of the range of motion (ROM) was measured during the sequential arthroscopic release of adhesions, with special regard to external rotation. Postoperative ROM and subjective shoulder function were also evaluated.MethodsEighteen patients treated with ORIF of the proximal humerus were scheduled to the unified arthroscopic procedures comprising sequential limited subacromial bursectomy, removal of the adhesions between the deltoid, plate, and humerus, as well as the plate removal. The ROM of the operated and opposite shoulders were assessed before surgery, intraoperatively and after a minimum two-year follow-up, with special regard to external rotation in adduction (AddER) and abduction (AbdER). Besides, the Constant-Murley score and Subjective Shoulder Value (SSV) were evaluated before a plate removal and after a minimum two-year follow-up after the surgery.ResultsDeltoid adhesion release correlated with considerable and statistically significant improvement of AddER (p < 0.0002) but not with the intraoperative range of AbdER. Significant improvement of AddER, but also of AbdER and other range of motion was noted at the follow-up. The improvement of the affected shoulder function following arthroscopic plate removal was considerable and statistically significant according to the modified Constant-Murley score (p < 0,01) and SSV (p < 0.0000) after a minimum of two-year follow-up.ConclusionsOur findings are the first to highlight the influence of deltoid muscle, plate, and humerus adhesions on limiting external rotation in adduction after ORIF treatment of proximal humerus fractures. These observations allow the identification of a new shoulder evaluation symptom: Selective Glenohumeral External Rotation Deficit (SGERD) as well as functional deltohumeral space.

【 授权许可】

CC BY