title: The outcome of scapulothoracic arthrodesis using cerclage wires, plates, and allograft for facioscapulohumeral dystrophy.
abstract: BACKGROUND
  Scapulothoracic arthrodesis is a recognized treatment for impaired shoulder function in patients with facioscapulohumeral dystrophy (FSHD) and is traditionally performed with autograft. The purpose of the study was to report our experience with scapulothoracic arthrodesis in patients with FSHD using allograft, rather than autograft, with particular respect to the effect of fusion on preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores; forced vital capacity (FVC); and complications.
  
  
  METHODS
  The early results of 14 consecutive scapulothoracic arthrodeses in FSHD patients with cerclage wires, plates, and allograft (fresh-frozen femoral heads) are reported. DASH scores were recorded preoperatively and 6 months postoperatively. Preoperative and 6-month FVCs were compared. The surgical technique is described.
  
  
  RESULTS
  Eleven patients underwent 14 fusions. The mean follow-up period was 29 months (range, 6-50 months). Forward flexion improved from 70° to 115° (P = .001) and abduction from 68° to 109° (P = .007). The DASH score improved from 48 points to 34 points (P = .005). FVC decreased from 98% to 92% of predicted (P = .021), although this was not clinically significant. One patient required revision for nonunion, and metalwork was removed in 5 scapulae. A postoperative chest infection developed in 1 patient and a pleural effusion in another. One brachial plexus palsy occurred, which had almost completely resolved by 27 months postoperatively.
  
  
  CONCLUSIONS
  Scapulothoracic arthrodesis can be performed successfully with allograft. The nonunion and complication rates are similar to those in the existing literature. A small decrease in FVC does occur but not to a clinically significant level.
authors.affiliation: Department of Orthopaedics and Trauma, Freeman Hospital, Newcastle upon Tyne, UK. Electronic address: adcooney@doctors.org.uk.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Cooney
authors.affiliation: Department of Orthopaedics and Trauma, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Inder
authors.initials: I
authors.lastname: Gill
authors.affiliation: Department of Orthopaedics and Trauma, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Stuart
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D001174:Arthrodesis / Q000295:instrumentation; D001860:Bone Plates; D016025:Bone Transplantation; D001864:Bone Wires; D005260:Female; D005270:Femur Head / Q000637:transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020391:Muscular Dystrophy, Facioscapulohumeral / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012272:Ribs / Q000601:surgery; D012540:Scapula / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Case Series; Level IV; Scapulothoracic arthrodesis; Treatment Study; allograft; facioscapulohumeral dystrophy; pulmonary function