Shoulder fusion after a self-inflicted gunshot wound: an injury pattern and treatment option.

Gunshot injuries to the shoulder are rare and difficult to manage. We present a case series of seven patients who sustained a severe shoulder injury to the non-dominant side as a result of a self-inflicted gunshot wound. We describe the injury as 'suicide shoulder' caused by upward and outward movement of the gun barrel as the trigger is pulled. All patients were male, with a mean age of 32 years (21 to 48). All were treated at the time of injury with initial repeated debridement, and within four weeks either by hemiarthroplasty (four patients) or arthrodesis (three patients). The hemiarthroplasty failed in one patient after 20 years due to infection and an arthrodesis was attempted, which also failed due to infection. Overall follow-up was for a mean of 26 months (12 to 44). All four hemiarthroplasty implants were removed with no feasible reconstruction ultimately possible, resulting in a poor functional outcome and no return to work. In contrast, all three primary arthrodeses eventually united, with two patients requiring revision plating and grafting. These patients returned to work with a good functional outcome. We recommend arthrodesis rather than replacement as the treatment of choice for this challenging injury.

Radiologic, mechanical, and histologic evaluation of 2 glenoid prosthesis designs in a canine model.

Aseptic loosening of glenoid components is a common problem associated with total shoulder arthroplasty. A new glenoid design aimed at improving fixation outcomes was compared with conventional keeled glenoids in weight-bearing canine shoulders. Radiographic, histologic, and mechanical tests were performed at 3 postoperative intervals (0, 3, and 6 months). The uncemented pegged glenoid achieved bone ingrowth around the peg flanges in each case. This result was confirmed histologically and radiographically. Mechanical results indicated that mean fixation strength increases significantly between 0 and 3 months after surgery and remains strong through 6 months. In contrast, conventional keeled glenoids were found to have partial or complete radiolucent lines around the keel in each instance, and mechanical testing demonstrated that mean fixation strength weakens significantly between 0 and 3 months after surgery and remains weak through 6 months. These results show that stem design changes can improve implant fixation. A cementless fluted peg stem was superior to a conventional cemented keel design in achieving osseous integration and fixation in a weight-bearing animal model.