A glenohumeral arthrodesis would be most beneficial to a patient with a flail shoulder but intact elbow and hand function. This is especially important for a laborer. It will allow the patient to have a stable base upon which to be able to use the hand. The position of arthrodesis is described in the review topic, and the goal is to position the shoulder so that the hand can reach the patient's mouth for feeding and groin for hygiene.
According to Clare et al. the indications include posttraumatic paralysis of the deltoid muscle and rotator cuff, brachial plexus injuries, chronic infection, failed revision arthroplasty, severe refractory instability, and bone deficiency following tumor resection.
The review by Safran & Iannotti noted marked improvements in pain and function in appropriately selected patients. Complications include nonunion, malposition, pain associated with prominent hardware, and periarticular fractures.
1. Hemiarthoplasty may be better for a younger patient with AVN.
2. Continued therapy and revision arthroscopic or open stabilization would be better choices.
4. Once the infection is treated, a second-stage re-implantation of a TSA, hemiarthroplasty or reverse TSA would be a better option.
5. Patients with cleidocranial dysostosis may benefit from scapulo-thoracic arthrodesis, not glenohumeral.
Safran O, Iannotti JP. Arthrodesis of the shoulder. J Am Acad Orthop Surg. 2006 Mar;14(3):145-53. Review.
PMID:16520365 (Link to Abstract)
Clare DJ, Wirth MA, Groh GI, Rockwood CA Jr. Shoulder arthrodesis. J Bone Joint Surg Am. 2001 Apr;83-A(4):593-600.
PMID:11315792 (Link to Abstract)