Early arthrodesis for a flail shoulder in young children

In seven children, five to nine years old, with a flail shoulder and a functional hand and elbow, arthrodesis of the shoulder in 80 to 90 degrees of abduction was performed by denuding the humeral head and glenoid of cartilage and fixing the humerus to the glenoid with Steinmann pins first inserted in the humerus in a proximal-distal direction and then driven in the reverse direction into the glenoid. Postoperatively each limb was immobilized in a spica cast, the pins were removed after a month, and the cast was removed after ten to twelve weeks when union was evident. All seven fusions united and function was much improved. When these children were followed to adult life there was only a small loss in humeral length and no change in position of the fused shoulder. Early arthrodesis is advocated in the treatment of a flail shoulder in children.