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

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.