OTA 2004 Posters
Stiffness after Proximal Humerus Fractures Treated with Arthroscopic Capsular Release and Subacromial Decompression
Purpose: Stiffness after a proximal humerus fracture can be both debilitating and frustrating for patients. Often, intensive physical therapy is unable to restore functional shoulder motion after such fractures. Arthroscopic capsular release and subacromial decompression has been described for those patients unable to obtain good motion and function after fracture healing. The purpose of this study was to document the efficacy of arthroscopic capsular release and subacromial decompression by quantifying the restoration of motion to patients who have sustained proximal humerus fractures.
Methods: The patient database of a sub-specialty orthopaedic practice was reviewed to identify patients treated with arthroscopic capsular release and subacromial decompression between 1999 and 2003. Twenty-four of these patients eventually required shoulder arthroscopic surgery for residual stiffness. Among these, 21 patients had adequate pre- and postoperative range-of-motion data recorded in their charts for review. Once Institutional Review Board approval was obtained for this retrospective study, we determined that, according to OTA classification, there were 11 11-A1, 3 11-A2, 2 11-A3, 3 11-B1, 1 11-B2, and 1 11C3 fractures within our sample. Ten of the 21 patients had had previous surgery for fracture fixation. All patients had arthroscopic capsular release, and 14 of the 21 patients received subacromial decompression with acromioplasty. Two patients with malunited greater tuberosity fractures required an osteotomy at the same time as their arthroscopic procedure. Range-of-motion values were recorded for forward elevation, external rotation, internal rotation, and abduction. Values from the immediate preoperative visit to the last postoperative visit were compared. Patient satisfaction level was also recorded.
Results: Of the 21 patients in the study, 14 were female and 7 were male, with a mean age of 51 (range, 20 to 79). The average delay from fracture to arthroscopic capsular release and decompression was 11.3 months; the average time from arthroscopy to the last follow-up visit was 6.4 months. All range-of-motion values improved statistically from the immediate preoperative to the final postoperative state. Overall, forward elevation improved from 95.9° to 142.8° (P = 0.001); external rotation improved from 20.4° to 44.1° (P = 0.016), abduction improved from 77.1° to 110.4° (P = 0.001), and internal rotation improved at least one level in 15 patients. When examined separately, patients receiving arthroscopy within 6 months of their fracture showed significant improvement in all range-of-motion parameters, and the magnitude of these changes was greater than that observed for all patients. When treated within 6 months, patient forward elevation improved from 82.6° to 147.8° (P = 0.002), external rotation improved from 16.4° to 45.8° (P = 0.000), abduction improved from 59.9° to 105.1° (P = 0.036), and internal rotation improved in 6 of 9 patients. There were no complications from the arthroscopic procedures. No patients required repeat procedures. All patients were satisfied with their outcome.
Conclusion/Significance: Patients with stiffness after proximal humerus fractures show significant improvements in range of motion after arthroscopic capsular release and subacromial decompression. Importantly, the findings of this study suggest that the greatest gains in motion are seen among those patients who undergo arthroscopic capsular release and decompression within 6 months of fracture healing.