THE ROLE OF SHOULDER FUSION IN THE ERA OF ARTHROPLASTY

The indications, surgical techniques, results and complications of sho ulder fusion are described The indications are bacterial infection, pa ralytic disorders in infancy, combined deltoid and rotator cuff paraly sis, post-traumatic brachial plexus lesions, inflammatory arthritis wi th severe rotator cuff involvement, failed arthroplasty, recurrent dis location, after resection of tumours, irreparable rotator cuff tear, p ainful arthritis in a patient whose activities require power but not m ovement, the immunocompromised patient, and tuberculosis. Satisfactory results are achieved in children with isolated shoulder paralysis, bu r in adults loss of glenohumeral movement is associated with about 50% loss of function. The best results are obtained in cases of isolated shoulder paralysis with a normal arm and hand distally. The most frequ ent complications are nonunion (5-20%), fracture of the ipsilateral hu merus (10-15%) and infection (3-5%). Other causes of failure are funct ional limitation, fusion in malposition, functional involvement of the distal joints, acromioclavicular dislocation, suprascapular fraction neuritis, failure or migration of an internal fixation device, epiphys eal problems and the complications of rising an allograft. Shoulder re placement is most likely to be chosen for most destructive shoulder di sorders, but fusion is useful in certain cases.