Four cases of tuberculosis of the shoulder which were treated by extra-ticular arthrodesis are presented. Three cases occurred in male children, and the fourth in an adult female. All involved the right shoulder joint. No history of local trauma was elicited in any case. The shortest duration of symptoms before diagnosis was made was two weeks and the longest duration was twenty-five years. Extra-articular fusion was done on these four patients, and bony ankylosis was demonstrated clinically and roentgenologically four to six months after operation. Ankylosis occurred in six months in the adult. female, in whom a previous intra-articular fusion had met with failure. The juvenile patients showed solid ankylosis in four to five months after operation, whereas conservative treatment for periods of six, eight, and twelve months, respectively, had failed to produce fusion.
The authors believe that extra-articular arthrodesis of the tuberculous shoulder joint should be carried out as soon as the diagnosis is established, provided that none of the more serious local or systemic complications are present. Intra-articular arthrodesis is unreliable, as evidenced by the failure of fusion in our adult patient, and conservative treatment furnishes no guarantee of healing, unless perhaps fixation be carried out for an interminable period. The shoulder joints of the four patients are healed and are functionally excellent.
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