Background: Although humeral shortening as a sequel of septic
arthritis of the shoulder in infants has been reported in previous studies,
functional disorders of the shoulder resulting from humeral shortening have
not yet been clarified. In this study, we retrospectively investigated the
long-term outcome of septic arthritis of the shoulder in neonates and infants
and examined the relationship between growth disturbance of the humerus and
decreased range of motion with respect to glenohumeral joint laxity.
Methods: We reviewed the cases of fifteen patients (sixteen
shoulders) with an age of a few days to 2.6 years at the onset of the disease
who were followed from 5.0 to 17.9 years. We noted the initial treatment
method and evaluated humeral length and shoulder function at the time of the
final follow-up. For the final treatment results, we classified the shoulders
with normal findings on radiographs as Grade I, those with humeral head
deformity as Grade II, and those with humeral head deformity with inferior
subluxation as Grade III.
Results: Primary treatment included arthrotomy in ten shoulders. The
delay between the onset of the disease and surgery ranged from three to
twenty-six days. At the time of the final follow-up, the results were Grade I
in five shoulders, Grade II in six shoulders, and Grade III in five shoulders.
The mean humeral shortening was 0.1 cm for Grade-I shoulders, 0.9 cm for
Grade-II shoulders, and 7.3 cm for Grade-III shoulders. All Grade-III
shoulders had =3 cm of shortening, and four of the five Grade-III shoulders
showed limitation of elevation (abduction of <130°). None of the
Grade-III shoulders had undergone arthrotomy within ten days after the onset
of the disease.
Conclusions: Inferior subluxation of the humeral head related to
shoulder dysfunction resulting from early childhood septic arthritis
accompanied humeral shortening of =3 cm and was only observed in patients
who did not undergo arthrotomy of the shoulder within ten days after the onset
of the infection.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.