title: Functional outcome of glenohumeral fusion in brachial plexus palsy: a report of 54 cases.
abstract: OBJECTIVE
  The restoration of shoulder function is a major issue in brachial plexus palsy. Although several tendon and nerve transfers have been described, shoulder arthrodesis remains a reliable technique in this context. This study planned to compare surgical and functional outcomes of 2 glenohumeral arthrodesis bone graft techniques: massive subacromial corticocancellous versus cancellous only grafts.
  
  
  METHODS
  We reviewed 54 patients who had shoulder arthrodesis according to 2 parameters after a mean follow-up of 37 months. The primary outcome measure was the rate of fusion according to the surgical technique. A total of 26 patients received a massive subacromial corticocancellous bone autograft, and 28 patients received only cancellous bone. The secondary outcome measure was the range of scapulothoracic motion measured by a video-assisted method according to type of neurological lesion. Brachial plexus palsy was complete in 32 cases and partial in 22 cases. All patients had recovered active elbow flexion before undergoing shoulder arthrodesis. Of the 54 patients, 48 had no postoperative immobilization.
  
  
  RESULTS
  The overall fusion rate was 76% after the first surgical procedure and 94% at last follow-up. Reoperation led to fusion in 10 cases, whereas 3 cases never fused. Pseudarthrosis rate after first surgery was 4% in the group with massive subacromial graft versus 43% in the group with cancellous bone graft. The mean range of motion was 59° in abduction (57° for complete palsy and 62° for partial palsy) with 42 cases 45° or greater. The mean range of motion was 48° in rotation (50° for complete palsy and 46° for partial palsy) with 35 cases 45° or greater.
  
  
  CONCLUSIONS
  Shoulder fusion provided active abduction greater than 45° in more than 75% of cases and active rotation greater than 45° in almost 65% of cases. Using a massive subacromial graft significantly reduced pseudarthrosis rate (P < .001).
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Orthopaedic Department, Bichat Hospital, Paris, France. drfranckatlan@gmail.com
authors.forename: Franck
authors.initials: F
authors.lastname: Atlan
authors.forename: Sébastien
authors.initials: S
authors.lastname: Durand
authors.forename: Michael
authors.initials: M
authors.lastname: Fox
authors.forename: Pierre
authors.initials: P
authors.lastname: Levy
authors.forename: Zoubir
authors.initials: Z
authors.lastname: Belkheyar
authors.forename: Christophe
authors.initials: C
authors.lastname: Oberlin
mesh_terms: D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D016025:Bone Transplantation; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult