Purpose
The purpose of this study was to determine the outcomes of arthroscopy after proximal
humeral plating and the occurrence of concomitant pathology and avascular necrosis.
Methods
Forty-five patients (28 women; median age, 58.5 years [range, 30 to 82 years]) underwent
arthroscopies of 46 shoulders because of unsatisfactory results after locked plating
of proximal humeral fractures. They were prospectively followed up for 3, 12, and
24 months postoperatively. Relevant intra-articular lesions were documented. The patients
were assigned to 1 of the following groups: (1) articular screw perforation, (2) subacromial
plate impingement, or (3) post-traumatic/postoperative shoulder stiffness. Shoulder
range of motion and function as measured with the age- and gender-adjusted Constant-Murley
score, as well as the Simple Shoulder Test, were compared among the groups.
Results
Concomitant lesions of the articular cartilage, long head of the biceps tendon, tuberosities,
and rotator cuff were found in 34 patients (75%). Two-thirds of patients (n = 31)
had a partial or complete 270° capsular release. Of the patients, 84% (n = 38) underwent
3 and 12 months' follow-up and 82% (n = 37) underwent 24 months' follow-up. The active
range of abduction (P = .029), flexion (P = .048), and internal rotation (P = .0005) had improved significantly at 24 months' follow-up compared with the preoperative
status. The mean adjusted Constant-Murley score of patients with post-traumatic shoulder
stiffness (n = 15, 64.2% ± 7.9%) and articular screw perforation (n = 19, 73.3% ±
8.4%) was significantly lower (P = .0089 and P = .042, respectively) than that of patients with subacromial plate impingement (n =
12, 93.4% ± 4.3%).
Conclusions
High rates of relevant articular pathologies and the necessity of capsular release
in a majority of patients with unsatisfactory results after locked plating of proximal
humeral fractures make arthroscopy a valuable revision tool with promising results
in cases of high plate positioning, screw perforation, and postoperative/post-traumatic
shoulder stiffness.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: June 14, 2014
Accepted:
April 11,
2014
Received:
November 12,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
