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

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.

Keywords: Constant–Murley shoulder score; arthrolysis; arthroscopy; extraction; intramedullary nail; post-operative dysfunction; proximal humerus fracture; screw; shoulder.

Figure 1

X-rays of fractures and osteosyntheses in two patients: (a) Fracture of proximal humerus in a 57-years-old man with intraarticular fracture 11C1.1 (AO) before and (b) 12 weeks after osteosynthesis with humeral intramedullary nail; as the nail is not protruding, only proximal locking screws would be removed during arthrolysis; (c) a 65-year-old woman with a proximal humerus fracture 11C3.1 before and (d) 6 weeks after osteosynthesis; the nail is protruding. All screws including the nail would be removed during arthrolysis.

Figure 2

Arthroscopic imagery. (left) Fibrous adhesions between the tendon of the supraspinatus muscle and the humeral head with a partially protruding end of the nail; (right) extraction of the protruding nail under arthroscopic control.

Figure 3

Constant–Murley score (CMS)—(left)—and forward flexion difference—(right)—between the individual patients’ conditions before and after the arthroscopic arthrolysis and osteosynthetic material extraction—boxplots including paired results of individual patients; please note that while positive change signifies an improvement in CMS, negative change indicates improvement in the parameter “Forward flexion difference between shoulders”.