EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE

Authors

  • Stanislav Bondarenko Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0003-2463-5919
  • Oleksandr Fomin National Pirogov Memorial Medical University, Vinnytsya. Ukrainе, Ukraine
  • Iurii Lazarenko National Pirogov Memorial Medical University, Vinnytsya. Ukrainе, Ukraine

DOI:

https://doi.org/10.15674/0030-5987202415-12

Keywords:

combat trauma, gunshot wounds, upper extremity, bone defects, 3D-implants

Abstract

As a result of large-scale war in Ukraine, the frequency of gunshot wounds of the upper extremities has increased dramatically, accompanied by massive damage to soft tissue, neurovascular plexuses, and significant bone deficiency, so their treatment with traditional methods is risky. This leads to the development of new treatment methods, in particular, techniques for shoulder arthrodesis. Objective. To investigate the effectiveness of shoulder arthrodesis using an individual 3D-titanium implant and or a locked compression plate (LCP) with bone autoplasty for the treatment of severe combat trauma of the upper extremity. Methods. In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). After 12 months, a decrease in pain (VAS: 5 to 1 points; p < 0.001) and improvement in the condition of the shoulder (Oxford Shoulder Score: 25 to 40 points, p < 0.001) were found compared with 6 months. Conclusions. Treatment of severe combat trauma of the upper extremity by shoulder arthrodesis allows to eliminate pain and restore sufficient function to perform daily tasks one year after surgery. The combination of shoulder arthrodesis with individual 3D-implants resulted in the restoration of upper limb function in all 9 patients with massive bone and muscle defects.

Author Biographies

Stanislav Bondarenko, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, DSci in Orthopaedics and Traumatology

Oleksandr Fomin, National Pirogov Memorial Medical University, Vinnytsya. Ukrainе

PhD

Iurii Lazarenko, National Pirogov Memorial Medical University, Vinnytsya. Ukrainе

PhD

References

  1. Zarutskyi, Ya. L., Bily, V. Ya., Denysenko, V. M., & Aslanyan, A. S. (2018). Military field surgery: a textbook. Kyiv : Phoenix. (in Ukrainian)
  2. Tsymbalyuk, V. I., Hayko, G. V., & Korol, S. O. (2020). Treatment of the wounded with combat injuries of the limbs. Kyiv : PJSC "PVK Desna. (in Ukrainian)
  3. Alta, T. D., & Willems, W. J. (2016). Once an arthrodesis, always an arthrodesis? Journal of Shoulder and Elbow Surgery, 25(2), 232-237. https://doi.org/10.1016/j.jse.2015.07.010
  4. Kılınç, M., Yıldırım, S. A., & Tan, E. (2015). The effects of electrical stimulation and exercise therapy in patients with limb girdle muscular dystrophy. Neurosciences, 20(3), 259-
  5. https://doi.org/10.17712/nsj.2015.3.201501097
  6. Wagner, E. R., McLaughlin, R., Sarfani, S., Cofield, R. H., Sperling, J. W., Sanchez-Sotelo, J., & Elhassan, B. T. (2018). Long-term outcomes of Glenohumeral arthrodesis. Journal of Bone and Joint Surgery, 100(7), 598-604. https://doi.org/10.2106/jbjs.17.00428
  7. Bondarenko, S., Filipenko, V., Ashukina, N., Maltseva, V., Ivanov, G., Lazarenko, I., Sereda, D., & Schwarzkopf, R. (2023). Comparative study in vivo of the osseointegration
  8. of 3D-printed and plasma-coated titanium implants. World Journal of Orthopedics, 14(9), 682-689. https://doi.org/10.5312/wjo.v14.i9.682
  9. Porcellini, G., Savoie, F. H., Campi, F., Merolla, G., & Paladini, P. (2014). Arthroscopically assisted shoulder arthrodesis: Is it an effective technique? Arthroscopy: The Journal of
  10. Arthroscopic & Related Surgery, 30(12), 1550-1556. https://doi.org/10.1016/j.arthro.2014.06.026
  11. Lovaglio, A., Socolovsky, M., Di Masi, G., & Bonilla, G. (2019). Treatment of neuropathic pain after peripheral nerve and brachial plexus traumatic injury. Neurology India, 67(7),
  12. https://doi.org/10.4103/0028-3886.250699
  13. Sousa, R., Pereira, A., Massada, M., Trigueiros, M., Lemos, R., & Silva, C. (2011). Shoulder arthrodesis in adult brachial plexus injury: What is the optimal position? Journal
  14. of Hand Surgery (European Volume), 36(7), 541-547. https://doi.org/10.1177/1753193411405742
  15. Thangarajah, T., & Lambert, S. M. (2017). Glenohumeral arthrodesis for late reconstruction of flail shoulder in patients with traumatic supraclavicular brachial plexus palsy. Shoulder & Elbow, 9(4), 266-271. https://doi.org/10.1177/1758573217693807
  16. Atlan, F., Durand, S., Fox, M., Levy, P., Belkheyar, Z., & Oberlin, C. (2012). Functional outcome of Glenohumeral fusion in brachial plexus palsy: A report of 54 cases. The Journal
  17. of Hand Surgery, 37(4), 683-688. https://doi.org/10.1016/j.jhsa.2012.01.012
  18. Kermarrec, G., Werthel, J. D., Canales, P., & Valenti, P. (2018). Review and clinical presentation in reverse shoulder arthroplasty in deltoid palsy. European Journal of Orthopaedic
  19. Surgery & Traumatology, 28(4), 747-751. https://doi.org/10.1007/s00590-018-2126-x
  20. Kusliy, Y. Y., Gunas, I. V., Fomin, O. O., & Lazarenko, Y. V. (2023). Correlations of the indicators of the distance of the shot and the type of clothing with the features of damage and
  21. gunshot residue when using the FORT 12R and AE 790G1 pistols. Perspectives and innovations of science Series: Medicine, 11(29), 638–647.
  22. Jouve, J., Bollini, G., Legre, R., Guardia, C., Choufani, E., Demakakos, J., & Blondel, B. (2014). Shoulder arthrodesis. European Surgical Orthopaedics and Traumatology, 1201-
  23. https://doi.org/10.1007/978-3-642-34746-7_234
  24. Ivalde, F. C., Bataglia, D., & Nizzo, G. (2017). Arthrodesis of the shoulder in patients with posttraumatic brachial plexus palsy: functional outcome and complications, Int J Adv Jt
  25. Reconstr., 4, 14–18.
  26. Adu-Kwarteng, K., Cabell, G. H., Hurley, E. T., Amanah, A. Y., Levin, J. M., Lassiter, T. E., Boachie-Adjei, Y. D., Klifto, C. S., & Anakwenze, O. (2023). Glenohumeral arthrodesis
  27. outcomes and complications: A systematic review. Journal of Shoulder and Elbow Surgery. https://doi.org/10.1016/j.jse.2023.10.025
  28. Goodman, G. P., & Engh Jr, C. A. (2016). The custom triflange cup. The Bone & Joint Journal, 98-B(1_Supple_A), 68-72. https://doi.org/10.1302/0301-620x.98b.36354

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How to Cite

Bondarenko, S. ., Fomin, O. ., & Lazarenko, I. . (2024). EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 5–12. https://doi.org/10.15674/0030-5987202415-12

Issue

No. 1 (2024)

Section

ORIGINAL ARTICLES

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