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Bosch TP, Beeres FJP, Ferree S, Schipper IB, Camenzind RS, Hoepelman RJ, Link BC, Rompen IF, Babst R, van de Wall BJM. Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review. J Clin Med 2024; 13:3344. [PMID: 38893055 PMCID: PMC11172441 DOI: 10.3390/jcm13113344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.
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Affiliation(s)
- Thomas P. Bosch
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frank J. P. Beeres
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Steven Ferree
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands (R.J.H.)
| | - Inger B. Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Roland S. Camenzind
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Ruben J. Hoepelman
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands (R.J.H.)
| | - Björn-Christian Link
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Ingmar F. Rompen
- Department of Surgery, University Hospital Heidelberg, 69117 Heidelberg, Germany
| | - Reto Babst
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Bryan J. M. van de Wall
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
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Kim YB, Choi HS, Park S, Park GC, Seo GW. Longitudinal changes in shoulder arthroplasty stratified by age groups, types of surgical facilities, and geographical regions in Korea from 2010 to 2020. J Shoulder Elbow Surg 2023; 32:e565-e570. [PMID: 37245622 DOI: 10.1016/j.jse.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Shoulder arthroplasty (SA), including hemiarthroplasty, reverse and anatomical total SA (TSA), improves quality of life by reducing shoulder pain and restoring function in patients not only with irreparable rotator cuff tears and/or cuff tear arthropathy but also with osteoarthritis posttraumatic arthritis, proximal humeral fractures, etc. Given the rapid developments in artificial joints and improvements in postoperative outcomes, the number of SA surgeries is increasing worldwide. Therefore, we investigated changes in trends over time in Korea. METHODS We analyzed the longitudinal changes in the incidence of SA including anatomic and reverse TSA, hemiarthroplasty, and shoulder revision arthroplasty (SRA) by changes in the Korean age profile, surgical facilities, and geographical regions using the Korean Health Insurance Review and Assessment Service database from 2010 to 2020. Data were also collected from the National Health Insurance Service and the Korean Statistical Information Service. RESULTS From 2010 to 2020, the TSA rate per 1,000,000 person-years increased from 10.571 to 101.372 (time trend = 1.252; 95% CI 1.233-1.271, P < .001). The shoulder hemiarthroplasty (SH) rate per 1,000,000 person-years decreased from 6.414 to 3.685 (time trend = 0.933; 95% CI 0.907-0.960, P < .001). The SRA rate per 1,000,000 person-years increased from 0.792 to 2.315; the increase was significant (time trend = 1.133; 95% CI 1.101-1.166, P < .001). DISCUSSION Overall, TSA and SRA are increasing and SH is decreasing. For both total TSA and SRA, steep increases are evident in the numbers of patients in their 70s and older than 80 years. The SH trend is decreasing regardless of differences in age groups, surgical facilities, and geographical regions. SRA is preferentially performed in Seoul.
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Affiliation(s)
- Yong-Beom Kim
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyung-Suk Choi
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Gee Chul Park
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Gi-Won Seo
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
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Gross BD, White CA, Wang KC, Patel AV, Parsons BO, Cagle PJ. The 50 most-cited articles in reverse shoulder arthroplasty. Shoulder Elbow 2023; 15:82-93. [PMID: 37974642 PMCID: PMC10649503 DOI: 10.1177/17585732231155123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 11/19/2023]
Abstract
Background Citation analyses have been used to understand the impact that a group of publications has on its field. As the techniques and indications of reverse total shoulder arthroplasty (RTSA) continue to expand, it is important to identify articles that can orient readers to the history, evolution, and current status of the body of RTSA literature. The purpose of this study was to identify and analyze the 50 most-cited articles related to RTSA. Methods Various Boolean queries were searched on the Clarivate Analytics Web of Science. Information collected included author name, publication year, country of origin, journal name, article type, total number of citations, and level of evidence. Results Top 50 most-cited articles amassed a total of 10,521 citations. The most-cited article was cited a total of 766 times. The most common study designs were case series (28) and cohort studies (9). Authors from the United States (24) contributed the most to included papers, followed by France (19) and Switzerland (8). Discussion The most-cited articles on RTSA are expert opinions, case studies, and cohort studies published by American authors. As RTSA continues to grow over the next decade, studies with higher levels-of-evidence may overtake articles included in this analysis.
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Affiliation(s)
- Benjamin D Gross
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Rivera AR, Cardona V. Reverse total shoulder arthroplasty for complex proximal humerus fracture in the elderly: clinical and radiological results. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:131-136. [PMID: 37588446 PMCID: PMC10426567 DOI: 10.1016/j.xrrt.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The use of reverse total shoulder arthroplasty (RSA) for the treatment of proximal humeral fractures (PHFs) is steadily increasing. Better clinical outcomes of RSA have been correlated with tuberosity reattachment and healing. The purpose of this study was to evaluate both the clinical and radiological results of reverse shoulder arthroplasty in the management of a proximal humerus fracture in the elderly. Methods Retrospective study including 400 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 12-month follow-up. In all the cases, the greater tuberosity was reattached with a standardized suture technique and a local bone graft. All the patients were assessed at the 12-month follow-up with Constant-Murley Score (CMS). Radiographic healing of the greater tuberosity was noted. Complications and revision rates were reported. Results Mean final CMS for this cohort was 82 points. The greater tuberosity healed in anatomic position in 85% of the cases (N = 340), obtaining an average CMS of 85 in these patients. Healing of the greater tuberosity did not occur in 13% of the cases (N = 52) and displacement more than 5 mm occurred in 2% (N = 8) of the patients for an average CMS of 60. All patients scored above 120° in forward elevation with a mean of 150°. Mean active external rotation was 35°. The lateralization shoulder angle had a mean of 91° and the distalization shoulder angle had a mean of 54°. Low-grade scapular notching was reported in <1% of the cases. A total of 60 patients presented failure of healing or displacement of the greater tuberosity. Major complications were reported in nine patients. Of these nine patients, two acquired superficial wound infections, while two had deep shoulder prosthetic infection. Two other patients developed hematomas, one sustained an acromial stress fracture, and two had a stem loosening. There were 4 reoperations. Conclusion Reverse shoulder arthroplasty, with the use of a fracture-specific stem, allows an improved rate of greater tuberosity healing and short-term clinical outcomes in the elderly population.
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Affiliation(s)
| | - Victor Cardona
- San Juan Bautista Medical School Caguas, Caguas, Puerto Rico
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Chaudhury S, Myatt R, Aboelmagd T, Hussain M, Malhas A. Two-year clinical and radiographic outcomes following uncemented reverse shoulder replacements for proximal humerus fractures. J Shoulder Elbow Surg 2023; 32:636-644. [PMID: 36243300 DOI: 10.1016/j.jse.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Uncertainty remains regarding the role and long-term outcomes following uncemented reverse shoulder replacements (RSRs) in managing displaced proximal humeral fractures (PHFs). Although RSRs for trauma have traditionally undergone cemented fixation of the humeral component, there is increasing interest in uncemented RSRs. Our primary aim was to evaluate 2-year outcomes following uncemented RSR fixation for 3- and 4-part PHFs in the elderly. A secondary aim was to evaluate if timing of surgery affected outcomes. METHODS This cohort series evaluated 2-year outcomes for 42 patients with Neer 3- and 4-part PHFs treated with uncemented RSRs between October 2016 and December 2019. Thirty-eight patients (90%) had clinical and radiologic follow-up at a minimum of 2 years. The primary outcomes compared postoperative range of movement, radiographic outcomes, and patient-reported outcome measures (PROMs). The PROMs collected included Oxford Shoulder Scores (OSSs), satisfaction scores, and the Friends and Family Test. The secondary outcome involved a subanalysis to see if outcomes were affected by treatment timing-within 2 weeks, 2-12 weeks, and >12 weeks. RESULTS The mean age of patients was 74.1 years (range 58-89). There were 11 males and 31 females. No intraoperative fractures were sustained. There was 1 transient axillary neurapraxia, which fully resolved by 4 months. Three patients required postoperative transfusions. During the study follow-up period, no patients developed either deep infections requiring a washout or dislocation, and none underwent further surgery. At 2-year follow-up, radiologic follow-up demonstrated tuberosity union in 29 of 38 cases (76%). Eight of 38 patients (21%) demonstrated some glenoid notching (Sirveaux 1 or 2 only) on radiographic follow-up. There was no evidence of loosening. The mean OSS was 38 (range 15-48). Mean range of movement achieved at 2 years was as follows: forward flexion 122° (50°-180°), abduction 116° (46°-180°), and external rotation 25° (range 5°-60°). Eighteen patients (47%) described their result as excellent, 17 (45%) as good, and 3 (8%) as poor. When comparing the time from injury to treatment, there was no statistically significant difference in complications or radiographic outcomes between the groups. Patients had a reduced forward flexion when treated between 2 and 12 weeks compared with the other groups (P = .019). CONCLUSION Uncemented RSR is a safe treatment option for the management of complex PHFs in the elderly. We report low complication rates, high patient satisfaction, and good outcomes at 2-year follow-up.
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Affiliation(s)
- Salma Chaudhury
- Royal Berkshire Hospital, Reading, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | | | | | | | - Amar Malhas
- Royal Berkshire Hospital, Reading, United Kingdom.
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Garofalo R, Fontanarosa A, Lassandro N, De Crescenzo A. Reverse Total Shoulder Arthroplasty with a Cementless and Metaphyseal Stem Fixation Is a Viable Option for the Treatment of Proximal Humeral Fractures with Calcar Involvement. J Clin Med 2023; 12:jcm12041443. [PMID: 36835978 PMCID: PMC9958614 DOI: 10.3390/jcm12041443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the suitability of reverse total shoulder arthroplasty (RTSA) with a cementless and metaphyseal stem fixation as a treatment for complex proximal humeral fractures (PHFs) with a calcar fragment when this may be fixed with a steel wire cerclage. Clinical and radiographic outcomes were compared with the same RTSA for PHFs without a calcar fragment at a minimum of five-year follow-up. METHODS A retrospective analysis was performed on acute PHFs "with a medial calcar fragment" (group A) and "without a calcar fragment" (group B) treated with a RTSA and cementless metaphyseal stem fixation. RESULTS At an average follow-up of 6.7 years (5-7.8 years), no statistical difference was observed comparing group A (18 patients) to group B (50 patients) for active anterior elevation (141 ± 15° vs. 145 ± 10°, p = 0.67), active external rotation ER1 (49 ± 15° vs. 53 ± 13°, p = 0.55), and active internal rotation (5 ± 2 vs. 6 ± 2, p = 0.97). Similarly, a comparison of ASES score (89.2 ± 10 vs. 91.6 ± 9, p = 0.23) and Simple Shoulder Test score (91.1 ± 11 vs. 90.4 ± 10, p = 0.49) revealed no significant difference. CONCLUSION RTSA with a cementless and metaphyseal stem fixation represents a safe and feasible treatment for complex PHFs with a medial calcar fragment when this may be fixed with a steel wire cerclage.
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Surgeon-designed patient-specific instrumentation improves glenoid component screw placement for reverse total shoulder arthroplasty in a population with small glenoid dimensions. INTERNATIONAL ORTHOPAEDICS 2023; 47:1267-1275. [PMID: 36763126 PMCID: PMC10079732 DOI: 10.1007/s00264-023-05706-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Glenoid component loosening is a potential complication of reverse total shoulder arthroplasty (rTSA), occurring in part due to lack of adequate screw purchase in quality scapular bone stock. This study was to determine the efficacy of a surgeon-designed, 3D-printed patient-specific instrumentation (PSI) compared to conventional instrumentation (CI) in achieving longer superior and inferior screw lengths for glenoid component fixation. METHODS A multi-centre retrospective analysis of patients who underwent rTSA between 2015 and 2020. Lengths of the superior and inferior locking screws inserted for fixation of the glenoid baseplate component were recorded and compared according to whether patients received PSI or CI. Secondary outcomes included operative duration and incidence of complications requiring revision surgery. RESULTS Seventy-three patients (31 PSI vs. 42 CI) were analysed. Average glenoid diameter was 24.5 mm (SD: 3.1) and 81% of patients had smaller glenoid dimensions compared to the baseplate itself. PSI produced significantly longer superior (44.7 vs. 30.7 mm; P < 0.001) and inferior (43.0 vs. 31 mm; P < 0.001) mean screw lengths, as compared to CI. A greater proportion of maximal screw lengths for the given rTSA construct (48 mm) were observed in the PSI group (71.9% vs. 11.9% superior, 59.4% vs. 11.9% inferior). Operative duration was not statistically significantly different between the PSI and CI groups (150 min vs. 169 min, respectively; P = 0.229). No patients had radiographic loosening of the glenoid component with an average of 2-year follow-up. CONCLUSION PSI facilitates longer superior and inferior screw placement in the fixation of the glenoid component for rTSA. With sufficient training, PSI can be designed and implemented by surgeons themselves.
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Is arthroplasty necessary for three and four-part proximal humerus fractures in elderly? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background/Aim: Proximal humerus fractures are common in elderly patients. Treatment of three and four-part fractures is especially controversial in these patients. In recent years, surgical options have been widely used, especially among shoulder surgeons. The purpose of this study was to compare clinical results of conservative and arthroplasty methods.
Methods: Between 2016 and 2020, 30 patients who were treated for Neer type 3 and type 4 proximal humeral fractures were included in the study. Patient data were evaluated retrospectively and then divided into three groups. Group 1 was treated conservatively, group 2 underwent hemiarthroplasty; and group 3 underwent reverse total shoulder arthroplasty. CONSTANT and visual analog scale (VAS) scores and radiological results at six months were evaluated retrospectively from patient records. At the last control they have been evaluated with CONSTANT, University of California/Los Angeles. (UCLA), and VAS scores.
Results: Twenty-three (76.7%) of the patients included in the study were females. The mean age was 73.5 (5.7) years. The mean follow-up period was 33 (2.5) months. The mean follow-up periods in groups 1–3 were 33.3 (2.9), 32.8 (2), and 32.2 (2.9) months, respectively. When the CONSTANT scores of the patients were compared at the sixth month, they were observed to be better in the reverse total shoulder arthroplasty group (P = 0.001). Final control CONSTANT scores in the hemiarthroplasty group were lower than in the other groups (P = 0.001) and similar in the reverse shoulder prosthesis and conservative treatment group (P = 1). When the UCLA scores of all groups were compared, the mean UCLA scores were found to be significantly higher in groups 1 and 3 compared to group 2 (P = 0.001). When the VAS scores of the patients were compared, a significant difference between all groups was detected (P < 0.05). The highest VAS scores were observed in group 2, the second highest in group 1, and the lowest in group 3.
Conclusion: For treatment of proximal humerus fractures in the elderly, patients should be evaluated according to activity levels and expectations, and surgical treatment should be suggested rather than ordered.
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Hohmann E, Keough N, Glatt V, Tetsworth K. Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03436-3. [PMID: 36454289 DOI: 10.1007/s00590-022-03436-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing surgical interventions for proximal humerus fractures. METHODS Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1-3 studies from 2000 to 2022 comparing surgical treatment with ORIF, IM nailing, hemiarthroplasty, total and reverse shoulder arthroplasty (RTS) was conducted. Clinical outcome scores, range of motion (ROM), and complications were included. Risk of bias was assessed using the Cochrane Collaboration's ROB2 tool and ROBINs-I tool. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS Thirty-five studies were included in the analysis. Twenty-five studies had a high risk of bias and were of low and very low quality. Comparisons between ORIF and hemiarthroplasty favored ORIF for clinical outcomes (p = 0.0001), abduction (p = 0.002), flexion (p = 0.001), and external rotation (p = 0.007). Comparisons between ORIF and IM nailing were not significant for clinical outcomes (p = 0.0001) or ROM. Comparisons between ORIF and RTS were not significant for clinical outcomes (p = 0.0001) but favored RTS for flexion (p = 0.02) and external rotation (p = 0.02). Comparisons between hemiarthroplasty and RTS favored RTS for clinical outcomes (p = 0.0001), abduction (p = 0.0001), and flexion (p = 0.0001). Complication rates between groups were not significant for all comparisons. CONCLUSIONS This meta-analysis for surgical treatment of proximal humerus fractures demonstrated that ORIF is superior to hemiarthroplasty, ORIF is comparable to IM nailing, reverse shoulder arthroplasty is superior to hemiarthroplasty but comparable to ORIF with similar clinical outcomes, ROM, and complication rates. However, the study validity is compromised by high risk of bias and low level of certainty. The results should therefore be interpreted with caution. Ultimately, shared decision making should reflect the fracture characteristics, bone quality, individual surgeon's experience, the patient's functional demands, and patient expectations. LEVEL OF EVIDENCE Level III; systematic review and meta-analysis.
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Affiliation(s)
- Erik Hohmann
- Faculty of Health Sciences, Medical School, University of Pretoria, Pretoria, South Africa.
- Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
- Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Natalie Keough
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Vaida Glatt
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA
- Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Kevin Tetsworth
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia
- Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia
- Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia
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The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population. J Clin Med 2022; 11:jcm11195832. [PMID: 36233699 PMCID: PMC9570675 DOI: 10.3390/jcm11195832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Proximal humerus fracture (PHF) is a common injury in the older population. While the majority of these fractures are treated non-operatively, a small subset of patients may benefit from surgical treatment. However, there continues to be an ongoing debate regarding the indications and ideal surgical treatment strategy. The use of reverse total shoulder arthroplasty (RTSA) has resulted in a paradigm shift in the treatment of PHFs in the older population. Unique biomechanical principles and design features of RTSA make it a suitable treatment option for PHFs in the older population. RTSA has distinct advantages over hemiarthroplasty and internal fixation and provides good pain relief and a reliable and reproducible improvement in functional outcomes. As a result, there has been an exponential increase in the volume of RTSA in the older population in last decade. The aim of this paper is to review the current concepts, outcomes and controversies regarding the use of RTSA for the treatment of PHFs in the older population.
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Lalehzarian SP, Agarwalla A, Liu JN. Return to work following shoulder arthroplasty: A systematic review. World J Orthop 2022; 13:837-852. [PMID: 36189336 PMCID: PMC9516623 DOI: 10.5312/wjo.v13.i9.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/13/2022] [Accepted: 08/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many patients prioritize the ability to return to work (RTW) after shoulder replacement surgeries such as total shoulder arthroplasty (TSA), reverse TSA (rTSA), and shoulder hemiarthroplasty (HA). Due to satisfactory clinical and functional long-term outcomes, the number of shoulder replacements performed will continue to rise into this next decade. With younger individuals who compose a significant amount of the workforce receiving shoulder replacements, patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.
AIM To summarize RTW outcomes following TSA, rTSA, and HA, and analyze the effects of workers’ compensation status on RTW rates and ability.
METHODS This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search regarding RTW following shoulder arthroplasty was performed using four databases (PubMed, Scopus, Embase, and Cochrane Library), and the Reference Citation Analysis (https://www.referencecitationanalysis.com/). All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included. Nonclinical studies, literature reviews, case reports, and those not reporting on RTW after shoulder arthroplasty were excluded.
RESULTS The majority of patients undergoing TSA, rTSA, or HA were able to RTW between one to four months, depending on work demand stratification. While sedentary or light demand jobs generally have higher rates of RTW, moderate or heavy demand jobs tend to have poorer rates of return. The rates of RTW following TSA (71%-93%) were consistently higher than those reported for HA (69%-82%) and rTSA (56%-65%). Furthermore, workers’ compensation status negatively influenced clinical outcomes following shoulder arthroplasty. Through a pooled means analysis, we proposed guidelines for the average time to RTW after TSA, rTSA, and HA. For TSA, rTSA, and HA, the average time to RTW regardless of work demand stratification was 1.93 ± 3.74 mo, 2.3 ± 2.4 mo, and 2.29 ± 3.66 mo, respectively.
CONCLUSION The majority of patients are able to RTW following shoulder arthroplasty. Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.
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Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine for USC, Los Angeles, CA 90033, United States
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Freislederer F, Trefzer R, Radzanowski S, Moro F, Scheibel M. [Anatomical fracture endoprosthesis-who and how?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:681-689. [PMID: 35833975 DOI: 10.1007/s00113-022-01212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
The aim of this review article is to present the indications for an anatomical fracture prosthesis, mostly as a shoulder hemiprosthesis (SHEP) and its value in comparison to other procedures. The healing of the tuberosities in the anatomical position and an intact rotator cuff are particularly important for the successful implantation of a SHEP after proximal humeral fractures. For older patients (> 70 years), the use of reverse shoulder arthroplasty achieves more reliable results and is associated with a lower revision rate. The indications for implantation of a SHEP in non-reconstructible proximal humeral fractures, usually with a head split, should be carefully considered and can be used in cases with well-preserved large tuberosities and in younger patients. Complications of SHEP, such as secondary rotator cuff insufficiency, tuberosity dislocation or resorption and secondary glenoid wear, can be treated using a conversion or a change to reverse shoulder arthroplasty.
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Affiliation(s)
- Florian Freislederer
- Schulter- und Ellbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Raphael Trefzer
- Schulter- und Ellbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
| | - Stephan Radzanowski
- Schulter- und Ellbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
| | - Fabrizio Moro
- Schulter- und Ellbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Schulter- und Ellbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Berlin, Deutschland
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Han PF, Yang S, Wang YP, Hou XD, Li Y, Li XY. Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update. Exp Ther Med 2022; 24:637. [PMID: 36160890 PMCID: PMC9468857 DOI: 10.3892/etm.2022.11574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022] Open
Abstract
The present meta-analysis was conducted to compare the safety and effectiveness of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in the treatment of osteoporotic proximal humeral fractures in elderly patients. The Embase, Pubmed Central, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical databases were searched between January 2009 and January 2022 to identify relevant studies. According to the search strategy, a total of 210 associated studies were retrieved and 16 were finally included. Review Manager 5.4 software was used for the data analysis. This study indicated that patients in the RSA group had significantly improved treatment outcomes compared with patients in the HA group, as assessed by Constant-Murley Shoulder Outcome Score (95% CI, 1.69-3.76; P<0.001), American Shoulder and Elbow Surgeons score (95% CI, 11.81-24.88; P<0.001) and shoulder range of motion (ROM; 95% CI, 3.41-9.07; P<0.001). However, the HA group was superior to the RSA group in terms of the Oxford Shoulder score (95% CI, 2.89-11.11; P<0.001). There was no significant statistical difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand score and complications. Overall, for the treatment of osteoporotic proximal humeral fractures in the elderly, the RSA group had improved postoperative ROM and functional scores compared with the HA group, without significant difference in the incidence of complications. However, HA remains a safe and reliable treatment option.
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Affiliation(s)
- Peng-Fei Han
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yue-Peng Wang
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Xue-Dong Hou
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yuan Li
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Xi-Yong Li
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Shoulder arthroplasty for proximal humeral fracture treatment: a retrospective functional outcome analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022:10.1007/s00590-022-03313-z. [PMID: 35759106 DOI: 10.1007/s00590-022-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Following proximal humeral fractures hemiarthroplasty (HA) or reversed total shoulder arthroplasty (rTSA) are performed if osteosynthesis or conservative treatment is not possible. HA has been reported to result in decreased functional outcomes compared with rTSA. Secondary shoulder arthroplasty, performed after a different initial treatment, has also been associated with inferior outcomes. METHODS Patients recieving a shoulder arthroplasty related to a proximal humeral fracture from 2010 to 2019 were included. A retrospective analysis of functional outcomes was performed using QuickDASH and subjective shoulder value (SSV). RESULTS The mean [standard deviation (SD)] follow-up time among the 82 included patients was 48 (28) months. The mean age was 70 (10) years. The mean age for HA was significantly different from rTSA [57 (9) and 72 (21) years; p < .001]. The mean QuickDASH score for primary arthroplasty was 11 (2) versus 12 (16) for secondary arthroplasty (p = .313). The mean SSV for primary arthroplasty was 84 (22) versus 82 (17) for secondary arthroplasty (p = .578). The mean QuickDASH score for HA was 24 (36) versus 9 (15) for rTSA (p = .346). The mean SSV for HA was 70 (34) versus 86 (17) for rTSA (p = .578). CONCLUSION Functional outcomes after fracture-related shoulder arthroplasty were excellent in an older population, even when performed secondarily after failed primary osteosynthesis or conservative treatment. No significant differences in shoulder function were identified between rTSA and HA, likely due to restrictive indications for HA.
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Lin CC, Karlin E, Boin MA, Dankert JF, Larose G, Zuckerman JD, Virk MS. Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202205000-00006. [PMID: 35536998 DOI: 10.2106/jbjs.rvw.21.00245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
» The majority of proximal humeral fractures (PHFs) in patients who are ≥65 years of age are treated nonoperatively, but certain complex fracture patterns benefit from surgical intervention. However, there continues to be debate regarding the indications for surgery and the optimal surgical treatment (repair versus replacement) in this population. » Reverse total shoulder arthroplasty (RTSA) has grown in popularity for surgical treatment of fracture-dislocations and displaced complex PHFs in patients who are ≥65 years of age; it has definite advantages over surgical repair and hemiarthroplasty, but this finding requires additional higher-quality evidence. » RTSA provides early pain relief and return of shoulder function as well as predictable elevation above shoulder level in the forward plane, but the indications for and understanding of the effect of timing on RTSA after a PHF continue to evolve. » RTSA for an acute PHF is indicated in patients who are ≥65 years of age with 3- and 4-part fracture-dislocations, head-split fractures, and severely displaced fractures, and is an option in patients who are not able to tolerate nonoperative treatment of severely displaced 3- and 4-part fractures. » RTSA is also indicated as a salvage operation for PHFs that have failed initial surgical repair (i.e., fixation failure, implant failure, rotator cuff failure, or osteonecrosis) and is an option for symptomatic nonunion or malunion after nonoperative treatment.
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Affiliation(s)
| | - Elan Karlin
- Georgetown University School of Medicine, Washington, DC
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Li H, Xu J, Zhang D, He Y, Chen X. Automatic surgical planning based on bone density assessment and path integral in cone space for reverse shoulder arthroplasty. Int J Comput Assist Radiol Surg 2022; 17:1017-1027. [PMID: 35489006 DOI: 10.1007/s11548-022-02633-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) is an effective surgery for severe shoulder joint diseases. Traditionally, the preoperative planning procedure of RSA is manually conducted by experienced surgeons, resulting in prolonged operating time and unreliable drilling paths of the prosthetic fixation screws. In this study, an automatic surgical planning algorithm for RSA was proposed to compute the optimal path of screw implantation. METHODS Firstly, a cone-shaped space containing alternative paths for each screw is generated using geometric parameters. Then, the volume constraint is applied to automatically remove inappropriate paths outside the bone boundary. Subsequently, the integral of grayscale value of the CT is used to evaluate the bone density and to compute the optimal solution. An automatic surgical planning software for RSA was also developed with the aforementioned algorithms. RESULTS Twenty-four clinical cases were used for preoperative planning to evaluate the accuracy and efficiency of the system. Results demonstrated that the angles among the prosthetic fixation screws were all within constraint angle(45°), and the stability rate of the planned prosthesis was 94.92%. The average time for the automatic planning algorithm was 4.39 s, and 83.96 s for the whole procedure. Repetitive experiments were also conducted to demonstrate the robustness of our system, and the variance of the stability coefficient was 0.027%. CONCLUSIONS In contrast to the cumbersome manual planning of the existing methods for RSA, our method requires only simple interaction operations. It enables efficient and precise automatic preoperative planning to simulate the ideal placement of the long prosthetic screws for the long-term stability of the prosthesis. In the future, it will have great clinical application prospects in RSA.
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Affiliation(s)
- Haitao Li
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - Jiangchang Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - Dingzhong Zhang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - Yaohua He
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. .,Department of Orthopaedics, Jinshan Branch of Shanghai Sixth People's Hospital Affiliated to Shanghai University of Medicine & Health Sciences, 147 Jiankang Road, Shanghai, 201503, China.
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China. .,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Simultaneous Bilateral Proximal Humerus Fractures Treated with Single-Stage Bilateral Reverse Shoulder Arthroplasty. Case Rep Orthop 2022; 2022:2162331. [PMID: 35496949 PMCID: PMC9045964 DOI: 10.1155/2022/2162331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 03/20/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Simultaneous bilateral fractures of the proximal humerus are infrequent, and simultaneous bilateral three- or four-part fractures are even rarer. Reverse shoulder arthroplasty (RSA) is being used increasingly for the treatment of three- and four-part fractures of the proximal humerus. However, treatment of simultaneous bilateral fractures of the proximal humerus is difficult because of concern about postoperative immobilization and rehabilitation. Case Presentation. A 75-year-old woman presented with bilateral shoulder pain subsequent to a fall on the street. Physical examination and radiographs showed simultaneous bilateral fractures of the proximal humerus. The right side fracture was classified as a four-part fracture and the left side fracture as a three-part fracture, according to Neer's classification. The right shoulder had a risk of avascular necrosis of the humeral head. For the left shoulder, the fracture type had caused ischemia of the humeral head. Single-stage bilateral RSA was performed 9 days after the injury. An abduction pillow was applied for 5 weeks postoperatively. Passive motion exercises were permitted starting at 4 weeks postoperatively, and active range of motion exercises were permitted at 6 weeks postoperatively. At the patient's most recent follow-up 30 months after surgery, the patient reported no restriction of the activities of daily living. Radiographs revealed no lucent line on the humerus and glenoid components, although bone resorption and superior retraction of the tuberosities on both sides were observed. Conclusions Single-stage bilateral RSA improved shoulder function, but healing of the greater tuberosity can affect the improvement in external rotation after the operation. Although a long-term follow-up is needed, single-stage bilateral RSA appears to be a viable treatment option.
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Skura B, Glazier MT, Schuette HB, Passias BJ, Chang IR, Verre J, Mehta S, Taylor BC. The Corkscrew Technique for Removing a Fibular Strut Allograft From the Proximal Humerus. Cureus 2022; 14:e23233. [PMID: 35449668 PMCID: PMC9012660 DOI: 10.7759/cureus.23233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/05/2022] Open
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Current Role of Reverse Total Shoulder Arthroplasty for Fractures of the Proximal Humerus. J Orthop Trauma 2022; 36:e98-e105. [PMID: 34294668 DOI: 10.1097/bot.0000000000002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Karelse A, Van Tongel A, Gosens T, De Boey S, De Wilde LF, Pouliart N. Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries. Expert Rev Med Devices 2021; 18:1189-1201. [PMID: 34903126 DOI: 10.1080/17434440.2021.2014318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data. Second, we determined whether known risk factors for prosthetic failure are being recorded. Through a non-systematic literature review studies on registries were analyzed for included parameters. Seven national registries were scrutinized for the data collected and these were classified according to categories of risk factors for failure: patient-, implant and surgeon related, and other parameters. This shows a large heterogeneity of registered parameters between countries. The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.
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Affiliation(s)
- Anne Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Orthopaedic Surgery and Traumatology, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Taco Gosens
- Department of Orthopaedic Surgery and Traumatology, Elisabeth Tweesteden Hospital, Tilburg/Waalwijk, The Netherlands
| | - Sara De Boey
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven F De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Nicole Pouliart
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Abstract
Background Fracture reverse shoulder arthroplasty (fRSA) in geriatric, complex dislocated proximal humerus fractures is becoming the standard treatment next to conservative treatment. fRSA is a multifaceted, reasonably challenging procedure of which functional outcomes and complication rates are likely to depend on the experience of the surgeon. The goal of this study was to determine whether there is a learning curve for fRSA. Methods All patients with a dislocated multipart proximal humerus fracture that were treated with an fRSA between 2013 and 2019 in a specialized institution were included. The functional outcomes (Constant Shoulder Score, Oxford Shoulder Score, and range of motion), complications, and operation time of fRSA were assessed with linear regression plots and cumulative summation analysis to establish whether a learning curve was present. Results In this cohort study, 50 patients were included. They had a mean age of 77.1 years and were treated with an fRSA by one trauma surgeon. Learning curves were distinguished for functional outcomes, complications, and operation time based on learning targets for daily activity and the mean complications and operation time. Results indicated that an optimal treatment is achieved after performing 20 fRSAs. Conclusion The results show that functional outcomes of PHFs treated with an fRSA improve with surgical experience. Also, outcomes are getting less variable after about 20 procedures. Surgeons starting this procedure should be aware of the learning curve and, therefore, should consider guidance from an experienced surgeon to swiftly optimize functional outcomes and prevent unnecessary complications.
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Heifner JJ, Kumar AD, Wagner ER. Reverse shoulder arthroplasty used for revision of reverse shoulder arthroplasty: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:329-334. [PMID: 37588710 PMCID: PMC10426696 DOI: 10.1016/j.xrrt.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background As reverse shoulder arthroplasty (RSA) cases increase, so too will the need to revise subsequent failures. Many of the complications associated with revising anatomic total shoulder and hemiarthroplasty have been adequately addressed by RSA including glenoid bone deficiency, instability, and functional outcomes. However, the risk for complication when revising a failed reverse prosthesis may be more pronounced with increased bone and soft tissue deficiency. The ability for the reversed prosthesis to accommodate these insufficiencies following a prior reversed prosthesis is unclear. Methods PubMed, Embase, and Google Scholar were queried for articles which fit the inclusion criteria of a reversed prosthesis used to revise a failed primary reverse prosthesis with a minimum follow-up of 12 months and clinical outcome reporting. Results After exclusions, 9 studies reporting on 242 reverse shoulders with a mean follow-up of 40.29 months were analyzed. The differences between preoperative and postoperative weighted means were not significant for Constant (P = .26), American Shoulder and Elbow Surgeons Shoulder score (P = .61), SSV (P = .57), and visual analog scale for pain (P = .48). Functional improvements in elevation (74°-102°) and external rotation (18°-21°) were consistent with those reported for primary reverse procedures, although differences in preoperative and postoperative measures were not statistically significant. Patient satisfaction was 89% with a major complication rate of 25%. Discussion The reverse shoulder prosthesis has proven satisfactory in revising hemiarthroplasty and anatomic total shoulder arthroplasty. The current results indicate RSA is also a satisfactory treatment option when revising a prior reverse prosthesis. Inherent to revision shoulder surgery is the obstacle of humeral and glenoid bone loss, an attenuated soft-tissue envelope, and instability. The reverse prosthesis may adequately address these commonly confronted difficulties with its inherent design characteristics. RSA provides a secure glenoid fixation for bone grafting, the ability to increase construct stability with component sizing, and a reliance on the deltoid for function. As our learning about revision of RSA improves, so will our ability to preemptively address potential issues which may lead to decreased complications in these cases. Despite the 25% rate of major complication, patients reported satisfaction of 89% which demonstrates the improvements in function and pain relief that are provided by the reverse prosthesis.
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Affiliation(s)
| | - Anjali D. Kumar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric R. Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Director of Upper Extremity Surgery Research, Atlanta, GA, USA
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Spross C, Zdravkovic V, Manser M, Farei-Campagna JM, Jacxsens M, Jost B. Outcomes of Management of Proximal Humeral Fractures with Patient-Specific, Evidence-Based Treatment Algorithms. J Bone Joint Surg Am 2021; 103:1906-1916. [PMID: 34129538 DOI: 10.2106/jbjs.20.01309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have identified risk factors for different types of treatment of proximal humeral fracture (PHF) and allowed the development of a patient-specific, evidence-based treatment algorithm with the potential of improving overall outcomes and reducing complications. The purpose of this study was to evaluate the results and complications of treating PHF using this algorithmic approach. METHODS All patients with isolated PHF between 2014 and 2017 were included and prospectively followed. The initial treatment algorithm (Version 1 [V1]) based on patients' functional needs, bone quality, and type of fracture was refined after 2 years (Version 2 [V2]). Adherence to protocol, clinical outcomes, and complications were analyzed at a 1-year follow-up. RESULTS The study included 334 patients (mean age, 66 years; 68% female): 226 were treated nonoperatively; 65, with open reduction and internal fixation (ORIF); 39, with reverse total shoulder arthroplasty (RTSA); and 4, with hemiarthroplasty. At 1 year, the preinjury EuroQol 5-Dimension (EQ-5D) values were regained (0.88 and 0.89, respectively) and the mean relative Constant Score (CS) and Subjective Shoulder Value (SSV) (and standard deviation [SD]) were 96% ± 21% and 85% ± 16%. Overall complications and revision rates were 19% and 13%. Treatment conforming to the algorithm outperformed non-conforming treatment with respect to relative CS (97% versus 88%, p = 0.016), complication rates (16.3% versus 30.8%, p = 0.014), and revision rates (10.6% versus 26.9%, p < 0.001). CONCLUSIONS Treating PHF using a patient-specific, evidence-based algorithm restored preinjury quality of life as measured with the EQ-5D and approximately 90% normal shoulders as measured with the relative CS and the SSV. Adherence to the treatment algorithm was associated with significantly better clinical outcomes and substantially reduced complication and revision rates. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christian Spross
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Acute Versus Delayed Reverse Shoulder Arthroplasty for the Primary Treatment of Proximal Humeral Fractures. J Am Acad Orthop Surg 2021; 29:832-839. [PMID: 33826552 DOI: 10.5435/jaaos-d-20-01375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/14/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Reverse total shoulder arthroplasty (rTSA) is gaining popularity as a treatment option for proximal humeral fractures in elderly patients. The impact of surgical timing on outcomes of primary rTSA is unclear. This study compared the rates of revision and complication, and surgery day cost of treatment between acute and delayed primary rTSA patients. METHODS Elderly patients with proximal humeral fracture who underwent primary rTSA within a year of fracture were identified in a national insurance database from 2005 to 2014. Patients were separated into acute (<4 weeks) or delayed (>4 weeks) cohorts based on the timing of rTSA. The univariate 1-year rates of revision and complication and surgery day cost of treatment were assessed. Multivariate logistic regression analysis was conducted, accounting for the factors of age, sex, obesity, diabetes comorbidity, and tobacco use. RESULTS Four thousand two hundred forty-five (82.6%) acute and 892 (17.4%) delayed primary rTSA patients were identified. Acute rTSA was associated with a higher surgery day cost (acute $15,770 ± $8,383, delayed $14,586 ± $7,271; P < 0.001). Delayed rTSA resulted in a higher 1-year revision rate (acute 1.7%, delayed 4.5%; P < 0.001) and surgical complication rates of dislocation (acute 2.8%, delayed 6.1%; P < 0.001) and mechanical complications (acute 1.9%, delayed 3.4%; P = 0.007). Multivariate analysis identified delayed primary treatment as independently associated with increased risk of revision (odds ratio: 2.29, 95% confidence interval 1.53 to 3.40; P < 0.001) and dislocation (OR: 2.05, 95% confidence interval 1.45 to 2.86; P < 0.001). CONCLUSION Delayed primary rTSA was associated with higher short-term rates of revision and dislocation compared with acute primary rTSA. Our results suggest that delaying rTSA, whether because of attempted nonsurgical treatment or patients' lack of access, may result in increased complication and additional surgery. LEVEL OF EVIDENCE Level III.
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Nyring MRK, Olsen BS, Amundsen A, Rasmussen JV. Minimal Clinically Important Differences (MCID) for the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) and the Oxford Shoulder Score (OSS). PATIENT-RELATED OUTCOME MEASURES 2021; 12:299-306. [PMID: 34588833 PMCID: PMC8473013 DOI: 10.2147/prom.s316920] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022]
Abstract
Background The minimal clinically important difference (MCID) is an important instrument in the interpretation of changes in patient-reported outcome measures (PROM). To our knowledge, no MCID of the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) score has ever been reported and no studies have reported an MCID for the Oxford Shoulder Score (OSS) based on patients with glenohumeral osteoarthritis, treated with an anatomical total shoulder arthroplasty (aTSA). The aim of this study was to determine MCID for WOOS and OSS in a cohort of patients with glenohumeral osteoarthritis treated with an aTSA. Methods All patients treated with an aTSA for glenohumeral osteoarthritis at our institution between March 2017 and February 2019 were included. Each patient completed the WOOS and the OSS preoperatively and one year postoperatively. At one year, the patients were asked to rate their overall improvement on a 7-point scale. We used an anchor-based method as our primary method to calculate the MCID, supported by two different distribution-based methods. Results A total of 45 primary aTSA were included. The MCID of WOOS was 12.3 according to the anchor-based method and 14.2 and 10.3 according to the two distribution-based methods. The MCID of OSS was 4.3 according to the anchor-based method and 5.8 and 4.3 according to the two distribution-based methods. Conclusion The anchor-based method is considered superior to the distribution-based method, and therefore we advocate to use this as MCID. For patients with glenohumeral osteoarthritis treated with an aTSA, the MCID values were 12.3 points for WOOS and 4.3 points for OSS. To our knowledge, this is the first study to report a MCID value for WOOS and the first study to report a MCID value for OSS in this subgroup of patients.
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Affiliation(s)
| | - Bo Sanderhoff Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, 2900, Denmark
| | - Alexander Amundsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup, 2900, Denmark
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Izquierdo-Fernández A, Gómez-Rodríguez M, Urbano-Luque M, García-Carmona M, Quevedo-Reinoso R, Minarro JC. Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up. J Orthop Traumatol 2021; 22:38. [PMID: 34559320 PMCID: PMC8463641 DOI: 10.1186/s10195-021-00597-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/01/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. MATERIAL AND METHODS A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. RESULTS After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. CONCLUSIONS At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. LEVEL OF EVIDENCE III Controlled cohort study.
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Affiliation(s)
| | - Marta Gómez-Rodríguez
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Maite Urbano-Luque
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Manuel García-Carmona
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Rafael Quevedo-Reinoso
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - José Carlos Minarro
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain.
- , Calle Buenos Aires 5B, 14006, Córdoba, Spain.
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Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus. J Clin Med 2021; 10:jcm10173841. [PMID: 34501288 PMCID: PMC8432246 DOI: 10.3390/jcm10173841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.
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Han X, Zhuang J, Yu W, Gao Y, Zhao M, Ye J, Han G, Zeng X. Conversion to hemi-shoulder arthroplasty or reverse total shoulder arthroplasty after failed plate osteosynthesis of proximal humerus fractures: a retrospective study. J Int Med Res 2021; 48:300060520931241. [PMID: 32867564 PMCID: PMC7469727 DOI: 10.1177/0300060520931241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the clinical outcomes of hemi-shoulder arthroplasty (HSA) versus reverse total shoulder arthroplasty (RTSA) following failed plate osteosynthesis of proximal humerus fractures in elderly patients. Methods This retrospective study identified all patients that had a documented failed plate osteosynthesis of proximal humeral fractures treated with revision HSA or RTSA. Follow-up occurred at 1, 3, 6 and 12 months after surgery and every year thereafter. The primary outcomes were the American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, visual analogue scale (VAS) pain scores and the University of California, Los Angeles Shoulder Rating Scale (UCLA SRS) scores. The secondary outcome was the rate of major complications. Results A total of 126 patients (126 shoulders) were enrolled in the study. At the final follow-up, the RTSA group had significantly greater improvements in ASES, SST and UCLA SRS scores than the HSA group. The RTSA group had significantly larger decreases in the VAS pain score compared with the HSA group. The rate of major complications was significantly higher in the HSA group than in the RTSA group (44.4% versus 27.5%, respectively). Conclusion RTSA provided superior functional outcomes compared with HSA, with a lower rate of major complications after a follow-up period of at least 5 years.
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Affiliation(s)
- Xiulan Han
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jintao Zhuang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yixin Gao
- Department of Blood Transfusion, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Junxing Ye
- Department of Orthopaedics, The Third People's Hospital of Wuxi and The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China
| | - Guowei Han
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Laas N, Engelsma Y, Hagemans FJA, Hoelen MA, van Deurzen DFP, Burger BJ. Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial. J Orthop Trauma 2021; 35:252-258. [PMID: 33470595 DOI: 10.1097/bot.0000000000001978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare outcomes between hemiarthroplasty (HA) and reversed shoulder arthroplasty (RSA) as a treatment for dislocated 3-part and 4-part proximal humerus fractures in the elderly population. DESIGN Prospective multicenter randomized controlled trial. SETTING Three Level-1 trauma centers. PATIENTS/PARTICIPANTS This study included 31 patients of which 14 were randomized into the HA group and 17 into the RSA group. INTERVENTION Patients randomized to the HA group were treated with a cemented-stem Aequalis-fracture HA and patients randomized to the RSA group with a cemented-stem Aequalis-fracture RSA. MAIN OUTCOME MEASUREMENTS Primary outcomes consisted of range of motion and constant score. Secondary outcomes were the visual analog scale for pain, DASH score, SF-12 scores, and radiographic outcomes. RESULTS After 6 and 12 months of follow-up, RSA showed a significant higher anterior elevation (105 degrees vs. 80 degrees, P = 0.002 and 110 degrees vs. 90 degrees, P = 0.02, respectively) and constant score (60 vs. 41, P = 0.01 and 51 vs. 32, P = 0.05, respectively) compared with HA. There were no significant differences in external and internal rotation. Also, visual analog scale pain, DASH scores, SF-12 scores, and radiological healing of the tuberosities and heterotopic ossification did not show any significant differences between groups. CONCLUSION RSA showed significant superior functional outcomes for anterior elevation and constant score compared with HA for dislocated 3-part and 4-part proximal humerus fractures after short-term follow-up. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Niels Laas
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Yde Engelsma
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Frans J A Hagemans
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Max A Hoelen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands ; and
| | - Derek F P van Deurzen
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Hospital, Amsterdam, the Netherlands
| | - Bart J Burger
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Xue Z, Pei Z, Zhang H, Tang C, Jia J, Zhang K, Zhang K, Wang L, Guan Z. Histological characteristics of bone in-growth of proximal humeral implants with different spatial structures. Aging (Albany NY) 2021; 13:4291-4298. [PMID: 33495410 PMCID: PMC7906205 DOI: 10.18632/aging.202391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
This study compares the longitudinal histological characteristics of proximal humeral implants with different spatial structures in rabbits. Thirty skeletally-mature male rabbits were divided into a trabecular structure group and regular hexahedron structure group according to the different spatial structures of a biological titanium alloy screw inserted into the greater tuberosity of the proximal humerus. Samples were collected 3, 6, and 12 weeks after the implantation surgery. Histological results showed that the amount of bone in-growth in the porous cavity of the screw implant increased over time. Quantitative analysis showed there was significantly more bone in-growth in the trabecular structure group than the classic structure group 3 weeks (25.4% ± 6.9% vs 19.6% ± 3.7%, P < 0.05) and 6 weeks (31.2% ± 1.7% vs 26.9% ± 5.3, P < 0.05) after the implantation surgery. No significant difference was detected between the two groups 12 weeks after the surgery (41.7% ± 2.5% vs 39% ± 4.1%, P > 0.05). Our data found that bone in-growth significantly differed among the three time points (P < 0.05) in both groups, but not between the implants with different spatial structures 12 weeks after the surgery.
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Affiliation(s)
- Zhe Xue
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zheng Pei
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Hui Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Chong Tang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Junxiu Jia
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Kun Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Keshi Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Luning Wang
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Haidian 100083, Beijing, P.R. China
| | - Zhenpeng Guan
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
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Schwarz AM, Hohenberger GM, Sauerschnig M, Niks M, Lipnik G, Mattiassich G, Zacherl M, Seibert FJ, Plecko M. Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience. BMC Musculoskelet Disord 2021; 22:48. [PMID: 33419418 PMCID: PMC7792308 DOI: 10.1186/s12891-020-03903-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA). METHODS This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals). RESULTS Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings. CONCLUSIONS RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- A M Schwarz
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria.
| | - G M Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - M Sauerschnig
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - M Niks
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - G Lipnik
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - G Mattiassich
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - M Zacherl
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - F J Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - M Plecko
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
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Walters JM, Ahmadi S. High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review. Geriatr Orthop Surg Rehabil 2020; 11:2151459320971568. [PMID: 33354380 PMCID: PMC7734485 DOI: 10.1177/2151459320971568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/29/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.
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Affiliation(s)
- Jordan M Walters
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shahryar Ahmadi
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5946 patients. J Shoulder Elbow Surg 2020; 29:2538-2547. [PMID: 32684280 DOI: 10.1016/j.jse.2020.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is an increasing trend toward the use of reverse total shoulder arthroplasty (RTSA) over stemmed hemiarthroplasty (HA) for the management of proximal humeral fractures. There are limited data available comparing the revision rates for RTSA and HA in the setting of a fracture. The aim of this study was to compare the revision rates for RTSA and HA when used for the treatment of a fracture and to analyze the effect of demographics and prosthesis fixation on these revision rates. METHODS Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from April 16, 2004, to December 31, 2017, included all procedures for primary diagnosis proximal humeral fracture. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models. RESULTS Over the study period, there were 3049 (51%) RTSA and 2897 (49%) HA procedures. The cumulative percent revision rate at 9 years was lower for the RTSA than for the HA: 7.0% (95% confidence interval [CI], 4.8-10.1) compared with 11.7% (95% CI, 10.3-13.2). Between 0 and 6 months, the HA had a significantly lower revision rate than the RTSA (hazard ratio, 0.50; 95% CI, 0.34-0.72; P < .001). Between 6 month and 3 years, the HA had a significantly higher revision rate. For the RTSA, males have a significantly higher rate of revision compared with females. There is a higher rate of early revision due to instability in younger persons (55-64) and males. For both RTSA and HA, cemented prostheses have lower revision rates compared with cementless prostheses. CONCLUSIONS RTSA has a significantly lower revision rate compared with HA for the treatment of proximal humeral fractures in females. Younger patients (<65) and males are at risk of early revision secondary to instability. In these patient groups, either alternatives to RTSA or further attention to fixation of tuberosities and shoulder rehabilitation may be indicated.
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Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review. INTERNATIONAL ORTHOPAEDICS 2020; 44:2673-2681. [PMID: 32995915 PMCID: PMC7679357 DOI: 10.1007/s00264-020-04813-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
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Song H, He T, Guo HMY, Li ZY, Wei M, Zhang C, Dong YQ. Locking Plates versus Locking Intramedullary Nails Fixation of Proximal Humeral Fractures Involving the Humeral Shaft: A Retrospective Cohort Study. Med Sci Monit 2020; 26:e922598. [PMID: 32772042 PMCID: PMC7437237 DOI: 10.12659/msm.922598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background For proximal humeral fractures (PHFs), locking intramedullary nails and locking plates have been widely used. However, few reports have been published on the therapy of complex PHFs accompanying humeral shaft fractures. Therefore, we performed this research to analyze the effectiveness of locking intramedullary nails and locking plates in the management of proximal humeral fractures involving the humeral shaft. Material/Methods We retrospectively reviewed 40 cases diagnosed with proximal humeral fractures involving the humeral shaft fixed with either locking intramedullary nails or locking plates with at least of 2 years’ follow-up. Clinical data were obtained from the medical records. Follow-up data included the Constant-Murley score, American Shoulder and Elbow Surgeons score (ASES), visual analog scale score (VAS), and the relative strength of the supraspinatus and deltoid muscles. Results In total, 19 locking plate patients and 21 locking intramedullary nail patients were analyzed. The average follow-up period was 35 months in the locking plate group and 34 months in the locking intramedullary nail group. There were obvious differences in the intraoperative blood loss, time of operation, and the length of operative incision between the 2 groups (p<0.05). There were no significant differences between the groups in Constant-Murley score, ASES, VAS, or the relative strength of supraspinatus and deltoid muscles. Conclusions For PHFs involving the humeral shaft, both locking plates and locking intramedullary nails can achieve satisfactory functional results in the long-term follow-up assessment. The locking intramedullary nail group was superior with regards to intraoperative blood loss, time of operation, and length of incision.
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Affiliation(s)
- Hui Song
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Tao He
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Hui-Min Y Guo
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Zhan-Yu Li
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Min Wei
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Chao Zhang
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Yu-Qi Dong
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
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Wendt KW, Jaeger M, Verbruggen J, Nijs S, Oestern HJ, Kdolsky R, Komadina R. ESTES recommendations on proximal humerus fractures in the elderly. Eur J Trauma Emerg Surg 2020; 47:381-395. [PMID: 32767081 DOI: 10.1007/s00068-020-01437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 07/12/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The section for the skeletal trauma and sport's injuries of the European Society for Trauma and Emergency Surgery (ESTES) appointed a task force group to reach a consensus among European countries on proximal humeral fractures. MATERIAL/METHODS The task force group organized several consensus meetings until a paper with final recommendations was confirmed during the ESTES Executive Board meeting in Berlin on 25 October 2018. CONCLUSION The Recommendations compare conservative and four possible operative treatment options (ORIF, nailing, hemi- and total reverse arthroplasty) and enable the smallest common denominator for the surgical treatment among ESTES members.
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Affiliation(s)
- Klaus W Wendt
- Medical Coordinator, Trauma Centre Northern Netherlands, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Jaeger
- Clinic for Orthopedic and Trauma Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Verbruggen
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stefaan Nijs
- Department of Traumatology, UZ Leuven, Leuven, Belgium
| | - Hans-Jörg Oestern
- Conciliation Board of Medical Liability Cases Germany, Hannover, Germany
| | - Richard Kdolsky
- University Clinic for Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Radko Komadina
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Kuhlmann NA, Taylor KA, Roche CP, Franovic S, Chen C, Carofino BC, Flurin PH, Wright TW, Schoch BS, Zuckerman JD, Muh SJ. Acute versus delayed reverse total shoulder arthroplasty for proximal humerus fractures in the elderly: Mid-term outcomes. ACTA ACUST UNITED AC 2020. [DOI: 10.1053/j.sart.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Linkous N, Wright JO, Koueiter DM, Marcantonio D, Wiater J, Wiater BP. Outcomes for reverse total shoulder arthroplasty after failed open reduction internal fixation versus primary reverse total shoulder arthroplasty for proximal humerus fractures. ACTA ACUST UNITED AC 2020. [DOI: 10.1053/j.sart.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carpenter DP, Feinstein SD, Van Buren ED, Lin FC, Amendola AN, Creighton RA, Kamath GV. Trends in open shoulder surgery among early career orthopedic surgeons: who is doing what? J Shoulder Elbow Surg 2020; 29:e269-e278. [PMID: 32336604 PMCID: PMC7305957 DOI: 10.1016/j.jse.2020.01.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of various open shoulder procedures has changed over time. In addition, various fellowships provide overlapping training in open shoulder surgery. There is a lack of information regarding the relationship between surgeon training and open shoulder procedure type and incidence in early career orthopedic surgeons. METHODS The American Board of Orthopaedic Surgery Part-II database was queried from 2002 to 2016 for reported open shoulder procedures. The procedures were categorized as follows: arthroplasty, revision arthroplasty, open instability, trauma, and open rotator cuff. We evaluated procedure trends as well as their relationship to surgeon fellowship categorized by Sports, Shoulder/Elbow, Hand, Trauma, and "Other" fellowship as well as no fellowship training. We additionally evaluated complication data as it related to procedure, fellowship category, and volume. RESULTS Over the 2002-2016 study period, there were increasing cases of arthroplasty, revision arthroplasty, and trauma (P < .001). There were decreasing cases in open instability and open rotator cuff (P < .001). Those with Sports training reported the largest overall share of open shoulder cases. Those with Shoulder/Elbow training reported an increasing overall share of arthroplasty cases and higher per candidate case numbers. The percentage of early career orthopedic surgeons reporting 5 or more arthroplasty cases was highest among Shoulder/Elbow candidates (P < .001). Across all procedures, those without fellowship training were least likely to report a complication (odds ratio [OR], 0.76; 95% confidence interval, 0.67-0.86; P < .001). Shoulder/Elbow candidates were least likely to report an arthroplasty complication (OR, 0.84, P = .03) as was any surgeon reporting 5 or more arthroplasty cases (OR, 0.81; 95% confidence interval, 0.70-0.94; P = .006). CONCLUSION The type and incidence of open shoulder surgery procedures continues to change. Among early career surgeons, those with more specific shoulder training are now performing the majority of arthroplasty-related procedures, and early career volume inversely correlates with complications.
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Affiliation(s)
- Daniel P. Carpenter
- Department of Orthopaedics, Washington University, Saint Louis, Missouri, USA
| | - Shawn D. Feinstein
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Eric D. Van Buren
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Robert A. Creighton
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ganesh V. Kamath
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, USA
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Yahuaca BI, Simon P, Christmas KN, Patel S, Gorman RA, Mighell MA, Frankle MA. Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:S32-S40. [PMID: 31948835 DOI: 10.1016/j.jse.2019.10.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humerus fracture treatment varies by surgeon preference and patient factors. This study compares patient and fracture characteristics, with outcomes between current surgical treatment options. METHODS Between 1999 and 2018, 425 proximal humerus fractures underwent acute surgical management: open reduction internal fixation (ORIF, n = 211), hemiarthroplasty (HA, n = 108), or reverse shoulder arthroplasty (RSA, n = 106). Patient and fracture characteristics included age, American Society of Anesthesiologists physical status classification (ASA), and fracture classification. Postoperative motion at 3, 6, and minimum 12 months (avg 20 ± 21 months), radiographic outcomes, and postoperative falls were analyzed. RESULTS Average age for treatment groups was 65 ± 13 years (range: 18-93 years). Fractures were classified as 2- (11%), 3- (41%), or 4-part (48%). Age, ASA, and fracture classification were associated with selected surgical management (P < .0001, =.001, <.0001, respectively). Outcomes showed a significant improvement in forward flexion from 3 months to 6 months in all groups (P < .0001). No difference in final motion was seen between groups. Radiographic union was higher in ORIF (89%), and similar between HA (79%) and RSA (77%, P = .005). Rate of reoperation was RSA 6.6%, ORIF 17.5%, and hemiarthroplasty 15.7% (P = .029). Postoperatively, 23% patients had at least 1 fall, of which 73% resulted in fractures. CONCLUSION Older patients with high ASA were treated with arthroplasty, and younger patients with lower ASA were treated with ORIF. All groups showed improvements in motion. At minimum 1 year of follow-up, there was no difference in motion between groups. ORIF and HA showed significantly more reoperations compared with RSA. Patients should be counseled about reoperation, fall risk, and prevention.
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Affiliation(s)
- B Israel Yahuaca
- Shoulder & Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Kaitlyn N Christmas
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Shaan Patel
- Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - R Allen Gorman
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Mark A Mighell
- Shoulder & Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Mark A Frankle
- Shoulder & Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA.
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Grassi FA, Alberio R, Ratti C, Surace MF, Piazza P, Messinese P, Saccomanno MF, Maccauro G, Murena L. Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont. Orthop Rev (Pavia) 2020; 12:8659. [PMID: 32913595 PMCID: PMC7459385 DOI: 10.4081/or.2020.8659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022] Open
Abstract
Shoulder replacement is indicated for the surgical treatment of proximal humeral fractures in elderly patients, when severe comminution and osteoporosis jeopardize the chances of success of any fixation technique. Two different implants are available for this purpose: anatomical hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA). HA for fractures was popularized by Charles Neer in the ‘50s and for several decades remained the only reliable implant for these injuries. However, many authors reported inconsistent results with HA as a consequence of the high rate of tuberosity and rotator cuff failure. In 1987, Paul Grammont designed the first successful RTSA, which was the end result of a long thought process on functional surgery of the shoulder. This implant was initially used to treat cuff tear arthropathy and shoulder pseudoparalysis, but indications have gradually expanded with time. Since RTSA does not rely on a functional cuff for shoulder elevation, it was felt that results in fractures could be improved by this prosthesis. In this study, the salient features of these implants are described to understand the rationale behind both approaches and highlight their pros and cons. Several clinical studies comparing HA vs RTSA for proximal humeral fractures have been published during the last two decades. A literature review is carried out to analyze and compare outcomes of both implants, analyzing clinical results, radiographic findings and complications. The final goal is to provide an overview of the different factors to consider for making a choice between these two prostheses.
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Affiliation(s)
- Federico A Grassi
- Orthopaedic and Trauma Unit, Department of Health Sciences, University Hospital University of East Piedmont, Novara
| | - Riccardo Alberio
- Orthopaedic and Trauma Unit, Department of Health Sciences, University Hospital University of East Piedmont, Novara
| | - Chiara Ratti
- Orthopaedic and Trauma Unit, Department of Medicine, Surgery and Health Sciences, University Hospital University of Trieste
| | - Michele F Surace
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese
| | - Piero Piazza
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piermarco Messinese
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giulio Maccauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Murena
- Orthopaedic and Trauma Unit, Department of Medicine, Surgery and Health Sciences, University Hospital University of Trieste
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine trends, outcomes, and principles in treatment of proximal humerus fractures in the elderly with a critical focus on reverse shoulder arthroplasty as a developing treatment option. RECENT FINDINGS Recent literature shows an increase in reverse shoulder arthroplasty and a decrease in hemiarthroplasty performed for proximal humerus fractures. More predictable outcomes and lower revision rates are seen in older individuals treated primarily or secondarily with reverse shoulder arthroplasty compared to those treated with hemiarthroplasty. We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old).
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Affiliation(s)
- Brandon J Kelly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Chad M Myeroff
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA. .,Regions Hospital, Saint Paul, Minnesota, 640 Jackson St, MS 11503L, Saint Paul, MN, 55101, USA. .,TRIA Orthopaedic Center, Woodbury, MN, USA.
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Antonios T, Bakti N, Phadkhe A, Gulihar A, Singh B. Outcomes following arthroplasty for proximal humeral fractures. J Clin Orthop Trauma 2020; 11:S31-S36. [PMID: 31992913 PMCID: PMC6977184 DOI: 10.1016/j.jcot.2019.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/19/2023] Open
Abstract
Fractures of the proximal humerus are very common and increasing in incidence within an ageing population. The majority of undisplaced fractures can be treated conservatively. Displaced fractures in good quality bone or in the young are considered for surgical fixation. However, displaced and comminuted fractures with or without dislocation, especially in the elderly, cannot be reliably treated with fixation. These patients are generally considered for joint arthroplasty. This review article focuses on the outcome following arthroplasty for proximal humeral fractures.
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Affiliation(s)
- Tony Antonios
- Department of Trauma & Orthopaedics, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK,Corresponding author.
| | - Nik Bakti
- Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | - Akshay Phadkhe
- Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | - Abhinav Gulihar
- Department of Trauma & Orthopaedics, Princess Royal University Hospital, Farnborough Common, Orpington, BR6 8ND, UK
| | - Bijayendra Singh
- Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK
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Peters PM, Plachel F, Danzinger V, Novi M, Märdian S, Scheibel M, Moroder P. Clinical and Radiographic Outcomes After Surgical Treatment of Proximal Humeral Fractures with Head-Split Component. J Bone Joint Surg Am 2020; 102:68-75. [PMID: 31596803 DOI: 10.2106/jbjs.19.00320] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Head-split fractures are a subgroup of proximal humeral fractures in which the fracture line affects the articular surface. Limited data are available regarding outcomes and risk factors for failure following surgical treatment of this rare fracture type. METHODS Of 45 patients with head-split fractures identified, a total of 30 (67%) were included in this retrospective study, with a mean follow-up of 49 ± 18 months (range, 12 to 83 months). Of those 30, 24 were treated with open reduction and internal fixation (ORIF), 4 with reverse total shoulder arthroplasty (RTSA), and 2 with hemiarthroplasty. Subjective Shoulder Value, Simple Shoulder Test, Constant score, and biplanar radiographs were assessed. Fracture pattern, quality of reduction, eventual complications, revision procedures, and clinical failure (adjusted Constant score < 40) were analyzed, and risk factors for failure were calculated. RESULTS The overall complication rate was 83% (ORIF: 21 of 24 [88%]; RTSA: 3 of 4 [75%]; and hemiarthroplasty: 1 of 2 [50%]). The most common complications following ORIF were humeral head osteonecrosis (42%), malunion of the lesser tuberosity (33%), and screw protrusion (29%), whereas all complications following RTSA were related to tuberosity problems. Revision was performed in 7 of 24 (29%) of initial ORIF patients, and no revisions were performed in RTSA or hemiarthroplasty patients. Four patients (17%) who underwent primary ORIF underwent conversion to RTSA, and 3 patients (12.5%) had screw removal due to penetration. The overall clinical failure rate was 50% (ORIF: 12 of 24 [50%]; RTSA: 1 of 4 [25%]; and hemiarthroplasty: 2 of 2 [100%]). No significant association was found between preoperative factors and clinical failure. ORIF and primary RTSA showed higher average clinical outcome scores than primary hemiarthroplasty and secondary RTSA. In general, patients who required revision had worse Subjective Shoulder Value (p = 0.014), Simple Shoulder Test (p = 0.028), and adjusted Constant scores (p = 0.069). CONCLUSIONS Head-split fractures of the humerus treated with ORIF showed high complication and revision rates. RTSA resulted in comparable clinical outcomes and complication rates; however, the complications associated with RTSA were mostly related to tuberosity problems, which in this small series did not require revision. Therefore, RTSA may be the most predictable treatment option for head-split fractures in elderly patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete list of levels of evidence.
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Affiliation(s)
- Paulina-Maria Peters
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,Institute of Tendon and Bone Regeneration, Paracelsus Medical University, Salzburg, Austria
| | - Victor Danzinger
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Michele Novi
- Azienda Ospedaliera Universitaria Pisana, Università di Pisa, Pisa, Italy
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Lehtimäki K, Rasmussen JV, Kukkonen J, Salomonsson B, Arverud ED, Hole R, Fenstadt AM, Brorson S, Jensen SL, Äärimaa V. Low risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures. JSES Int 2020; 4:151-155. [PMID: 32195478 PMCID: PMC7075766 DOI: 10.1016/j.jses.2019.10.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background Reverse shoulder arthroplasty (RSA) has gained popularity in the treatment of proximal humeral fractures (PHFs), especially in elderly patients. The purpose of this study was to investigate the use of RSA implants for acute PHFs and risk of revision, as well as risk factors for revision. Methods RSA implants for acute PHFs were identified from the Nordic Arthroplasty Register Association registry data from 2004 to 2016. Kaplan-Meier survival analysis was used to calculate implant survival. Cox multiple regression analysis was used to calculate the adjusted revision rate for sex, age, country of operation, and year of surgery. Results The study included 1523 RSA implants for PHFs (84% women; average age, 77 years; average follow-up time, 2.5 years). The 5-year cumulative implant survival rate was 97% (confidence limits, 95.5% and 98%). Revision was performed for 33 implants (2%). The most common reason for revision was instability, occurring in 11 cases (0.7%), followed by fracture, occurring in 6 (0.4%), and infection, occurring in 5 (0.3%). Four different arthroplasty brands were used in this cohort, with the Delta Xtend in two-thirds of cases (n = 1025). Age younger than 60 years and male sex were associated with slightly higher rates of revision; however, these differences did not reach statistical significance (hazard ratio of 2.02 with P = .075 and hazard ratio of 3.23 with P = .057, respectively). Conclusion The use of RSA for acute PHFs is increasing in the Nordic countries. The short-term risk of revision is low. The main reason for revision of RSA for this indication is instability.
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Affiliation(s)
- Kaisa Lehtimäki
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeppe V Rasmussen
- Department of Orthopedic Surgery, Herlev Hospital, University of Copenhagen, Herlev, Copenhagen
| | - Juha Kukkonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Björn Salomonsson
- Division of Orthopedics, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Erica D Arverud
- Division of Orthopedics, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Randi Hole
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne-Marie Fenstadt
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stig Brorson
- Department of Orthopedic Surgery, Zealand University Hospital, University of Copenhagen, Herlev, Copenhagen
| | - Steen Lund Jensen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, García-Fernández C, Picado AL, Marco F. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg 2019; 28:2259-2271. [PMID: 31500986 DOI: 10.1016/j.jse.2019.06.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures (PHFs) are among the most common fractures in elderly patients, but there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for their management. To date, no RCT has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for 3- or 4-part PHFs in elderly patients. METHODS This was a prospective RCT. The primary objective was to compare pain and function 12 months after fracture using the Constant score in patients aged 80 years or older with 3- and 4-part PHFs, treated by either RSA or nonoperative treatment. Secondary outcome measures included Disabilities of the Arm, Shoulder and Hand, visual analog scale (VAS), Short Form 12 (SF-12), EuroQol 5 Dimensions, and EQ-VAS scores. RESULTS We analyzed 30 nonoperative and 29 RSA patients with mean ages of 85 years and 82 years, respectively. No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes at 12 months' follow-up except the VAS pain score. The Constant scores were 55.7 in the nonoperative group and 61.7 in the RSA group (P = .071); the Disabilities of the Arm, Shoulder and Hand scores were 29 and 21, respectively (P = .075); the VAS scores were 1.6 and 0.9, respectively (P = .011); the physical SF-12 scores were 36 and 37, respectively (P = .709); the mental SF-12 scores were 43 and 42, respectively (P = .625); the EuroQol 5 Dimensions scores were 0.89 and 0.92, respectively (P = .319); and the EQ-VAS scores were 65 and 67, respectively (P = .604). CONCLUSIONS This study yields important evidence for the treatment of complex PHFs in elderly patients suggesting minimal benefits of RSA over nonoperative treatment for displaced 3- and 4-part PHFs. At short-term follow-up, the main advantage of RSA appeared to be less pain perception.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.
| | - Borja Alcobía-Díaz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - María Galán-Olleros
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Amanda López Picado
- Clinical Trials and Research Unit, Clínico San Carlos Hospital, IdISSC, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain
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McLean AS, Price N, Graves S, Hatton A, Taylor FJ. Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017. J Shoulder Elbow Surg 2019; 28:2072-2078. [PMID: 31420225 DOI: 10.1016/j.jse.2019.03.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus as to the treatment of proximal humeral fractures (PHFs), particularly in elderly patients. There is increasing evidence that nonoperative management may have similar functional outcomes to operative management, which is potentially conflicting with increasingly improved surgical techniques and implants. The aim of this study was to investigate the changes in the incidence and management of PHFs across Australia over a 10-year period. MATERIALS AND METHODS We retrospectively reviewed all hospitalizations of patients with PHFs from 2 Australian national health care databases from 2008 to 2017. We recorded the incidence of PHFs and annual utilization rates of commonly used treatment options including nonoperative management, hemiarthroplasty (HA), reverse total shoulder arthroplasty (RTSA), and open reduction-internal fixation (ORIF). RESULTS The incidence of PHFs increased from 26.8 per 100,000 person-years in 2008 to 45.7 per 100,000 person-years in 2017. There was a decrease in operative management from 2008 to 2017, with 32.5% and 22.8% of all PHFs treated operatively in 2008 and 2017, respectively (P = .001). ORIF use decreased significantly from 76.6% to 72.6% (P = .004). RTSA use increased significantly from 4.1% to 24.5% (P < .001). HA use decreased significantly from 19.3% to 3% (P < .001). CONCLUSIONS Whereas the incidence of PHFs increased, the operative management of PHFs decreased significantly from 2008 to 2017, particularly in patients aged 65 years or older. This decrease in operative management was in part due to a significant decrease in ORIF and HA use in patients aged 65 years or older. There was a significant increase in RTSA use.
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Affiliation(s)
- Andrew S McLean
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, QLD, Australia.
| | - Nathan Price
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, SA, Australia
| | - Alesha Hatton
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Fraser J Taylor
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, QLD, Australia
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Ceri L, Mondanelli N, Sangaletti R, Bottai V, Muratori F, Giannotti S. Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: A case report. Trauma Case Rep 2019; 23:100242. [PMID: 31463352 PMCID: PMC6710294 DOI: 10.1016/j.tcr.2019.100242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Proximal humeral fracture is the third most common fracture in elderly people after fractures of proximal femur and distal radius. They typically occur after low-energy trauma in women affected by osteoporosis, bilateral involvement is rare and usually with a simple pattern of fracture. Bilateral four-part proximal humerus fractures are even less frequent, with only a few reports published previously, with all of them caused by a seizure or electrocution in patients < 65 years old. CASE PRESENTATION We present a 77-year-old right-handed female that sustained a bilateral simultaneous four-part humeral fracture secondary to accidental slip-and-fall occurred at home. Patient was treated with simultaneous bilateral Reverse Shoulder Arthroplasty (RSA) in our structure. Functional assessment was undertaken at 6- and 12-months follow-up (FU) after surgery, using the Constant-Murley score (CMS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. OUTCOME The simultaneous RSA procedure was well tolerated by the patient. Post-operative course was optimal with relatively low blood loss, rapid functional recovery, and fast pain relief. The CMS and DASH score were reasonably good at 6-months FU (right-left: 39-57 and 50.8-30.5, respectively) and they further improved at 1-year FU (right-left: 66-82 and 35.8-19.2, respectively). X-rays showed good position of the implants with no evidence of scapular notching at 1 year. Patient rated the overall satisfaction as good. DISCUSSION Bilateral four-part proximal humeral fractures are complex injuries difficult to manage. Optimal treatment is controversial, and it can be conservative or surgical, varying from open reduction and internal fixation (ORIF) to arthroplasty. However, this last option is still directed to only one side, preferring ORIF or conservative treatment for the contralateral. In case of comminute and displaced fractures, low bone quality, rotator cuff deficiencies and eccentric osteoarthritis, RSA is to prefer as a surgical option. For these reason, in selected cases of bilateral four parts proximal humerus fracture, especially when occurs in elderly patients, the simultaneous RSA implantation can represent a valid option to achieve an adequate functional result and a fast recovery. This is the first description, to our knowledge, in English literature of a simultaneous bilateral RSA.
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Affiliation(s)
- Lorenzo Ceri
- Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy
| | - Rudy Sangaletti
- Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy
| | - Vanna Bottai
- Second Orthopedic and Traumatological Clinic, University of Pisa, Pisa, Italy
| | - Francesco Muratori
- Orthopeadic Oncology Unit, Azienda Ospedaliero Universitaria careggi, Firenze, Italy
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences: Section of Orthopedics and Traumatology, University of Siena, Siena, Italy
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Torrens C, Alentorn-Geli E, Mingo F, Gamba C, Santana F. Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes. J Orthop Surg (Hong Kong) 2019; 26:2309499018760132. [PMID: 29486672 DOI: 10.1177/2309499018760132] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate the influence of greater tuberosity healing on the functional outcomes of reverse shoulder arthroplasty (RSA) for the treatment of acute complex proximal humeral fractures (PHFs), and to investigate the influence of patient- and surgery-related factors in the healing of the greater tuberosity. METHODS Retrospective study including 41 consecutive PHFs treated using RSA with minimum 2-year follow-up. In all the cases, tuberosities were reattached with a standardized technique. All the patients were assessed at the last follow-up with constant score. Body mass index, surgery delay, comorbidities, polyethylene size, glenosphere size, overhanging of glenosphere, and scapular notch were recorded, and their influence in final constant score and in greater tuberosity healing was analyzed. RESULTS Mean final constant score was of 60.7 points (standard deviation (SD) = 9.9). Greater tuberosity healed in proper position in 68% of the cases. There were no significant differences in constant score between patients with (mean = 61; SD = 9.5) and without (mean = 61; SD = 11.3) the healing of greater tuberosity. All patients scored above 90° in forward elevation. Scapular notch was reported in 14.6% of the cases. Age significantly affected the constant score ( p = 0.008). Comorbidities significantly interfered with greater tuberosity healing ( p = 0.03). There was one reoperation after dislocation. CONCLUSION In spite of expecting good functional outcome with low complication rate after RSA for acute PHFs, the influence of greater tuberosity healing on shoulder function could not be demonstrated. The presence of comorbidities, but not age or gender, negatively influenced the healing of the greater tuberosity.
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Affiliation(s)
- Carlos Torrens
- 1 Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Alentorn-Geli
- 2 Fundación García-Cugat, Barcelona, Spain.,3 Artroscopia GC, SL, Hospital Quirón, Barcelona, Spain.,4 Mutualidad Catalana de Futbolistas, Federación Española de Fútbol, Barcelona, Spain.,5 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Felipe Mingo
- 1 Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Carlo Gamba
- 1 Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Fernando Santana
- 1 Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
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