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Humeral Shortening and Inferior Subluxation as Sequelae of Septic Arthritis of the Shoulder in Neonates and Infants
Takashi Saisu, MD1; Akira Kawashima, MD2; Makoto Kamegaya, MD1; Motohiko Mikasa, MD3; Joji Moriishi, MD4; Hideshige Moriya, MD5
1 Division of Orthopaedic Surgery, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan. E-mail address for T. Saisu: h-saisu@dc4.so-net.ne.jp
2 Kawashima Orthopaedics, 1-24-7 Kouzunomori, Narita 286-0048, Japan
3 Matsudo Orthopaedic Hospital, 1-161 Asahi-cho, Matsudo 271-0043, Japan
4 Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 274-0822, Japan
5 Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Aug 01;89(8):1784-1793. doi: 10.2106/JBJS.E.01021
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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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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