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Papadopoulos DV, Kakogeorgou V, Mullen JR, Kontogeorgakos V, Nikolaou VS, Babis G. Non-union of the greater tuberosity in patients undergoing reverse total shoulder arthroplasty for proximal humerus fracture: Is it associated with worse outcomes? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04108-0. [PMID: 39331134 DOI: 10.1007/s00590-024-04108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND 4-part proximal humerus fractures are complex injuries that are often associated with comminution of the greater tuberosity. The purpose of this study is to evaluate the functional outcomes of 4-part humerus fractures that are treated with reverse total shoulder arthroplasty (rTSA) and correlate these outcomes with the healing status of the greater tuberosity. MATERIAL AND METHODS A retrospective observational study was performed including 65 patients who underwent rTSA following a 4-part proximal humerus fracture. These patients were categorized into 3 groups according to the healing status of the greater tuberosity: patients with healed greater tuberosity in an anatomical position (group A, n = 43), patients with non-union of the greater tuberosity but in anatomical position (group B, n = 14), and patients with resorption or non-union of the greater tuberosity not in anatomical position (group C, n = 8). The Constant-Murley score and range of motion were recorded for each patient at 12 months postoperatively. The clinical and radiographical outcomes of the 3 groups were compared. RESULTS Patients with healed greater tuberosity (group A) had higher range of motion compared to patients with greater tuberosity migration or reabsorption (group C) regarding forward flexion (130° vs 80°, p < 0.001), abduction (110° vs 65°, p < 0.001) and external rotation (20° vs 10°, p = 0.004). However, no significant changes regarding forward flexion (130° vs 125°, p = 0.67), abduction (110° vs 100°, p = 0.60) and external rotation (20° vs 25°, p = 0.37) were noted between patients with healed greater tuberosity (group A) and those with non-united greater tuberosity that remained attached to the humeral prosthesis (group B). Similarly, Constant- Murley score was similar between patients of group A and group B (65.0 vs 61.5, p = 0.53), while it was higher in patients of group A compared to those of group C (65.0 vs 39.0, p = 0.053). CONCLUSIONS The outcomes of this study indicate that reliable recovery regarding range of motion and functional status can be achieved in patients who undergo rTSA due to 4-part proximal humerus fractures, as long as the greater tuberosity remains in close proximity to the humeral prosthesis, even if it has signs of non-union with no continuity to the adjacent humerus.
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Affiliation(s)
- Dimitrios V Papadopoulos
- Second Department of Orthopaedic Surgery, School of Medicine, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, 14233, Athens, Greece.
| | - Vasiliki Kakogeorgou
- Second Department of Orthopaedic Surgery, School of Medicine, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, 14233, Athens, Greece
| | | | - Vasileios Kontogeorgakos
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Vasileios S Nikolaou
- Second Department of Orthopaedic Surgery, School of Medicine, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, 14233, Athens, Greece
| | - George Babis
- Second Department of Orthopaedic Surgery, School of Medicine, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, 14233, Athens, Greece
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Buchanan TR, Reddy AR, Bindi VE, Hones KM, Holt KE, Wright TW, Schoch BS, Wright JO, Kaar SG, King JJ, Hao KA. The effect of tuberosity healing on functional outcomes after reverse shoulder arthroplasty for proximal humerus fractures: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06310-5. [PMID: 39249532 DOI: 10.1007/s00264-024-06310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 09/01/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE This systematic review and meta-analysis compared clinical outcome measures in patients undergoing reverse shoulder arthroplasty (RSA) for proximal humerus fracture (PHF) with healed versus non-healed greater tuberosity (GT). METHODS We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines querying PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane for studies that stratified results by the GT healing status. Studies that did not attempt to repair the GT were excluded. We extracted and compared clinical outcomes including postoperative forward flexion (FF), external rotation (ER), internal rotation (IR), Constant score, and complications and revision rates. RESULTS Of the included patients, 295 (78.5%) demonstrated GT healing while 81 did not (21.5%). The healed GT cohort exhibited increased postoperative FF (P < .001), ER (P < .001), IR (P = .006), and Constant score (P = .006) compared to the non-healed GT cohort. The overall dislocation rate was 0.8% with no study differentiating GT status of dislocation cases. CONCLUSION Healing of the GT after RSA for PHF yields improved postoperative range of motion and strength, whereas patient-reported pain and function were largely not affected by GT healing indicating merit to RSA for PHF regardless of the likelihood of the GT healing.
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Affiliation(s)
| | - Akshay R Reddy
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Victoria E Bindi
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Kara E Holt
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Scott G Kaar
- Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, MO, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
| | - Kevin A Hao
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
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Bindi VE, Buchanan TR, Cueto RJ, Hones KM, Wright TW, Schoch BS, King JJ, Hao KA. Mitigating the Risk of Instability After Reverse Shoulder Arthroplasty: A Critical Analysis Review of Patient and Surgical Factors. JBJS Rev 2024; 12:01874474-202409000-00001. [PMID: 39226391 DOI: 10.2106/jbjs.rvw.24.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
» Instability and dislocation after reverse shoulder arthroplasty may occur in up to 31% of patients. » Clinical risk factors for instability include younger age, male sex, increased body mass index, preoperative diagnosis of proximal humerus fracture or rotator cuff pathology, history of instability of the native shoulder or after surgery, and a medical history of Parkinson's disease. » Patients with rheumatoid arthritis and decreased proximity to the coracoid may also be at greater risk. » In patients at a high risk of instability, surgeons should consider a more lateralized prosthesis (particularly in patients with an incompetent rotator cuff), repairing the subscapularis (particularly when using a medialized prosthesis), and upsizing the glenosphere (>40 mm in male and 38-40 mm in female patients). » While potentially useful, less evidence exists for the use of a constrained liner (particularly with a lateralized glenosphere and/or in low-demand patients) and rotating the polyethylene liner posteriorly to avoid impingement.
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Affiliation(s)
- Victoria E Bindi
- College of Medicine, University of Florida, Gainesville, Florida
| | | | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, Florida
| | - Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Kevin A Hao
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
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Curry M, Tornberg H, Fedorka CJ. Single-stage bilateral uncemented reverse shoulder arthroplasty for traumatic proximal humerus fractures: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:504-510. [PMID: 39157217 PMCID: PMC11329036 DOI: 10.1016/j.xrrt.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Michael Curry
- Department of Orthopaedic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Haley Tornberg
- Department of Orthopaedic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Catherine J. Fedorka
- Department of Orthopaedic Surgery, Cooper University Health Care, Camden, NJ, USA
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Fischer CS, Lohr C, Ziegler P, Schüll D, Finger FC, Histing T, Herbst M, Hemmann P. Clinical and radiological outcome following trauma-related reverse shoulder arthroplasty. Arch Orthop Trauma Surg 2024; 144:3103-3111. [PMID: 38847836 PMCID: PMC11319594 DOI: 10.1007/s00402-024-05395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is a frequently used therapy for complex proximal humeral fractures and posttraumatic disorders. The present study's purpose was to assess the clinical and radiological outcome of primary and secondary RSA, and to analyze the impact of refixation of the greater tuberosity (GT). PATIENTS AND METHODS 28 patients with primary fracture RSA and 18 patients with RSA due to posttraumatic disorders were examined with a mean clinical follow-up of 2.5 ± 1.73 years. Operative details and radiographs were retrospectively reviewed. Additional analyses were performed for healed and non-healed GT in primary RSA. RESULTS Patients with fracture RSA had higher Constant-Murley score (CMS) than secondary RSA without reaching significance (p = 0.104). No significant difference was present for the quality of life measured by the Short Form 36 (SF 36) and the range of motion. In primary RSA, 78.6% GT healed anatomically. Compared to non-healed GT, patients with healed GT had a significantly higher CMS (p = 0.011), external rotation (p = 0.026) and forward flexion (p = 0.083), whereas DASH score was lower without a significant difference (p = 0.268). SF 36 showed no significant difference. Patients with healed GT had a more neutral glenoid version (p = 0.009). CONCLUSION Superior range of motion and clinical outcome scores were present for anatomically healed GT. Therefore, refixation of the tuberosities is recommended. Secondary RSA can result in inferior results compared to primary RSA, so patients need to be adequately informed.
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Affiliation(s)
- Cornelius Sebastian Fischer
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Christian Lohr
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Patrick Ziegler
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, Via Arona 34, St. Moritz, 7500, Switzerland
| | - Daniel Schüll
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Felix Christioph Finger
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
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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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Derksen A, Lill H, Ellwein A, Imrecke J. Tuberosity refixation improves functional outcome following primary reverse shoulder arthroplasty in proximal humeral fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1441-1448. [PMID: 38240825 DOI: 10.1007/s00590-023-03810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/15/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The purpose of this prospective study was to examine clinical results of tuberosity refixation in RSA for the treatment of displaced PHF in elderly patients. We hypothesized that tuberosity refixation would increase clinical outcome. METHODS In this prospective study, 50 patients were included after receive a primary RSA for complex proximal humeral fracture between March 2013 and December 2015 for follow-up after three, 12 and 24 months. A functional and radiological assessment was performed on the patients. RESULTS At final follow-up after a mean period of 25.1 months, data were available for 30 women and 6 men (74% of the included overall study collective) with a mean age of 77 years (range 55-93 years) at time of surgery. The tuberosities were refixated in 74% (n = 37) and in 26% (n = 13) resected. RSA with tuberosity refixation resulted in better clinical shoulder function compared to RSA with non-refixated tuberosities. The data show an external rotation with a significant difference (24.9° vs. 14°, p < 0.05) in favor of participants with refixation. The raw CMS was statistically significant (71.3 vs. 56.3, p < 0.05) after refixation, and SSV was significant improved (82.7% vs. 68%, p < 0.05) in the same group. Among 3 of 50 patients a total of 3 complications occurred with a total of 6% surgical revision. CONCLUSIONS In this prospective study, tuberosity refixation as part of fracture treatment using RSA results in better external rotation, subjective assessment of shoulder recovery (measured by SSV and by raw CMS) in elderly patients, compared with tuberosity excision. LEVEL OF EVIDENCE II, Prospective comparative study.
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Affiliation(s)
- Alexander Derksen
- Department of Orthopaedic Surgery at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
| | - Helmut Lill
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Alexander Ellwein
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Julia Imrecke
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
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Porcellini G, Montanari M, Giorgini A, Micheloni GM, Bonfatti R, Tarallo L. Great tuberosity fixation does not affect healing and clinical outcomes in RSA performed in proximal humeral fractures in elderly patients. Musculoskelet Surg 2024; 108:107-114. [PMID: 38175393 DOI: 10.1007/s12306-023-00807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Aims of our study were to define whether the great tuberosity (GT) positioning fixation in reverse shoulder arthroplasty (RSA) after proximal humeral fracture (PHF) could predict tuberosity healing and its impact on clinical outcomes. METHODS We enrolled 59 patients treated with cementless reverse shoulder arthroplasty after PHF in our institute between 2012 and 2018. The mean follow-up was 57 months (± 23.4). We divided patients into two groups according to GT positioning after fixation: Group 1 GT in contact and Group 2 GT detached at least 1 mm from humeral diaphysis. Clinical and radiographic evaluations were conducted at last follow-up. RESULTS Overall GT healing rate was 64.4%, (Group 1 70.7%-Group 2 50%). A statistically significant difference (P = 0.047) was found in cortical thickness narrowing at one-third of stem length. We found a correlation between lateral cortical narrowing and GT fixation in non-anatomical position, but we observed no statistically significant differences about GT healing according to GT anatomical or non-anatomical fixation. No differences were found in shoulder function in patients whose tuberosity was healed or failed to heal. CONCLUSION GT reduction is not a predictive factor for GT healing; external stress shielding, instead, seems to be decreased in patients with postoperative anatomically reduced GT. In our study, GT healing did not affect clinical outcomes or patient's satisfaction in elderly low-demanding patients.
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Affiliation(s)
- Giuseppe Porcellini
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Marta Montanari
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy.
| | - Andrea Giorgini
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Gian Mario Micheloni
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Rocco Bonfatti
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Luigi Tarallo
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
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Sasanuma H, Iijima Y, Saito T, Saitsu A, Saito T, Matsumura T, Takeshita K. Efficacy of fracture stem in reverse shoulder arthroplasty for 3- or 4-part proximal humerus fractures. J Orthop Sci 2023; 28:1266-1273. [PMID: 36550015 DOI: 10.1016/j.jos.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/11/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study compared the clinical results of fracture stems and conventional stems using the same glenoid component in reverse shoulder arthroplasty for proximal humerus fractures in the elderly. METHODS This retrospective study included 35 patients who underwent Grammont-type reverse shoulder arthroplasty for proximal humerus fractures from 2014 to 2020. The average age at surgery was 79.2 (range, 65-92) years, with 33 female shoulders. Fracture types per Neer classification were 3-part fracture, 4-part fracture, in 13 and 22 shoulders, respectively. The final follow-up period was 35 (range, 24-81) months. The Constant score, American Shoulder and Elbow Surgeons score, shoulder range of motion, and healing of greater tuberosities at the final follow-up of AEQUALIS™ REVERSED (Conventional stem group: n = 15) and AEQUALIS™ REVERSED FX (Fractured stem group: n = 20) were retrospectively investigated. RESULTS There were no statistically significant differences in age at surgery, sex, body mass index, fracture type, waiting time from injury to surgery, or preoperative general condition between the groups. The Constant and American Shoulder and Elbow Surgeons scores of the fractured stem group were significantly higher than those of the conventional stem group (P = 0.038 and P = 0.023, respectively). The anterior elevation and external rotation at the side of the fractured stem group also showed significantly higher values than those of the conventional stem group (fractured stem group vs. conventional stem group: anterior elevation 127° ± 25° vs. 105° ± 35°, P = 0.041; external rotation 28° ± 13° vs. 13° ± 12°, P = 0.015). The greater tuberosity healing rate was 46.7% (7/15) in the conventional stem group and 85.0% (17/20) in the fractured stem group (P=0.027). CONCLUSIONS The findings suggest that use of a fracture-specific stem rather than a conventional stem in Grammont-type reverse shoulder arthroplasty for proximal humerus fractures improves tuberosity healing, postoperative range of motion, and clinical scores.
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Affiliation(s)
- Hideyuki Sasanuma
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yuki Iijima
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tomohiro Saito
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Akihiro Saitsu
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Toshihiro Saito
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tomohiro Matsumura
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Katsushi Takeshita
- Jichi Medical University Hospital, Department of Orthopaedics, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Cassart Masnou E, Pérez Andrés R, Mora Solé E, García Perdomo D, Ruiz Macarrilla L. Anatomic greater tuberosity healing does not influence the functional outcomes of reverse shoulder arthroplasty for acute proximal humerus fractures. Shoulder Elbow 2023; 15:60-68. [PMID: 37974640 PMCID: PMC10649508 DOI: 10.1177/17585732221089864] [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: 06/27/2021] [Accepted: 03/08/2022] [Indexed: 11/19/2023]
Abstract
Background To investigate the functional outcomes of reverse shoulder arthroplasty (RSA) in acute complex proximal humerus fractures (PHF) in patients with an anatomic greater tuberosity union in comparison to patients with a displaced or resorbed tuberosity. Method It is a retrospective study with prospective data collection including 32 consecutive PHF with a minimum two-year follow-up treated with RSA. A radiological study and a CT scan were performed specifically for the study. Two shoulder surgeons and a musculoskeletal radiologist assessed the position and union of the greater tuberosity. The functional outcomes were assessed with the Constant-Murley, DASH, ASES and ADLER scores. Results The mean overall CS was 59.55. In 17 cases, the greater tuberosity healed in an anatomical position. In 15 cases, it was non-anatomical. In 53% of patients, greater tuberosity union was obtained. The CS was 62.76 in the anatomic union group and 55.9 in the non-anatomic union group. No significant differences were observed. No differences were observed in the ASES, DASH and ADLER scores. Conclusion After RSA for PHF, anatomic greater tuberosity healing was obtained in 53% of patients. The influence of the position and union of the greater tuberosity on the functional results could not be evidenced.
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Affiliation(s)
- E Cassart Masnou
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - R Pérez Andrés
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - E Mora Solé
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D García Perdomo
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Ruiz Macarrilla
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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11
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Ripoll T, Chelli M, Johnston T, Chaoui J, Gauci MO, Vasseur H, Poltaretskyi S, Boileau P. Three-Dimensional Measurement of Proximal Humerus Fractures Displacement: A Computerized Analysis. J Clin Med 2023; 12:4085. [PMID: 37373779 DOI: 10.3390/jcm12124085] [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: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Neer's classification for proximal humerus fractures (PHFs) uses 10 mm and 45° thresholds to distinguish displaced fragments. While this system was originally developed referencing 2D X-rays, fracture displacements occur in three dimensions. Our work aimed to develop a standardized and reliable computerized method for measuring PHF 3D spatial displacements. CT scans of 77 PHFs were analyzed. A statistical shape model (SSM) was used to generate the pre-fracture humerus. This predicted proximal humerus was then used as a "layer" to manually reduce fragments to their native positions and quantify translation and rotation in three dimensions. 3D computerized measurements could be calculated for 96% of fractures and revealed that 47% of PHFs were displaced according to Neer's criteria. Valgus and varus head rotations in the coronal plane were present in 39% and 45% of cases; these were greater than 45° in 8% of cases and were always associated with axial and sagittal rotations. When compared to 3D measurements, 2D methods underestimated the displacement of tuberosity fragments and did not accurately assess rotational displacements. The use of 3D measurements of fracture displacement is feasible with a computerized method and may help further refine PHF analysis and surgical planning.
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Affiliation(s)
- Thomas Ripoll
- Unité de Recherche Clinique (UR2CA), Université de Nice Côté d'Azur, 06000 Nice, France
- Hôpital Pasteur 2-IULS, 30 Voie Romaine, CÉDEX 1, 06001 Nice, France
| | - Mikaël Chelli
- Institut de Chirurgie Réparatrice-Groupe Kantys, 06004 Nice, France
| | - Tyler Johnston
- Unité de Recherche Clinique (UR2CA), Université de Nice Côté d'Azur, 06000 Nice, France
- Hôpital Pasteur 2-IULS, 30 Voie Romaine, CÉDEX 1, 06001 Nice, France
| | | | - Marc-Olivier Gauci
- Unité de Recherche Clinique (UR2CA), Université de Nice Côté d'Azur, 06000 Nice, France
- Hôpital Pasteur 2-IULS, 30 Voie Romaine, CÉDEX 1, 06001 Nice, France
| | - Heloïse Vasseur
- Hôpital Pasteur 2-IULS, 30 Voie Romaine, CÉDEX 1, 06001 Nice, France
| | | | - Pascal Boileau
- Institut de Chirurgie Réparatrice-Groupe Kantys, 06004 Nice, France
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12
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Sheng N, Shi T, Wang Q, Wang L, Chen Y. Nonanatomic healing of the greater tuberosity after plating in proximal humeral fractures: a case control study. J Orthop Surg Res 2023; 18:374. [PMID: 37208767 DOI: 10.1186/s13018-023-03811-8] [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: 06/25/2022] [Accepted: 04/23/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Open reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation. METHODS We retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors. RESULTS There were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was. CONCLUSIONS Nonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.
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Affiliation(s)
- Ning Sheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Tingwang Shi
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Qiuke Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Lei Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Yunfeng Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
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13
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Troiano E, Peri G, Calò I, Colasanti GB, Mondanelli N, Giannotti S. A novel "7 sutures and 8 knots" surgical technique in reverse shoulder arthroplasty for proximal humeral fractures: tuberosity healing improves short-term clinical results. J Orthop Traumatol 2023; 24:18. [PMID: 37155113 PMCID: PMC10167075 DOI: 10.1186/s10195-023-00697-4] [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: 11/15/2022] [Accepted: 04/02/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Complex proximal humeral fractures (cPHFs) represent an important public health concern, and reverse shoulder arthroplasty (RSA) has emerged as a feasible treatment option in the elderly with high functional demands. Recent studies have shown that tuberosity healing leads to better clinical outcomes and an improved range of motion. However, the best surgical technique for the management of the tuberosities is still a topic of debate. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients who underwent RSA for cPHFs using a novel "7 sutures and 8 knots" technique. MATERIALS AND METHODS A consecutive series of 32 patients (33 shoulders) were treated with this technique by a single surgeon from January 2017 to September 2021. Results at a minimum follow-up of 12 months and a mean ± SD follow-up of 35.9 ± 16.2 (range 12-64) months are reported. RESULTS The tuberosity union rate was 87.9% (29 out of 33 shoulders), the mean Constant score was 66.7 ± 20.5 (range 29-100) points, and the mean DASH score was 33.4 ± 22.6 (range 2-85) points. CONCLUSIONS The "7 sutures and 8 knots" technique, which relies on three sutures around the implant and five bridging sutures between the tuberosities, is a relatively simple procedure which provides a reliable means for anatomic restoration of the tuberosities and allows functional recovery of the shoulder in elderly patients with cPHFs treated with RSA. LEVEL OF EVIDENCE IV; retrospective atudy. TRIAL REGISTRATION At our institution, no institutional review board nor ethical committee approval is necessary for retrospective studies.
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Affiliation(s)
- Elisa Troiano
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Giacomo Peri
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Irene Calò
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Giovanni Battista Colasanti
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy.
| | - Stefano Giannotti
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
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14
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Doll J, Neide A, Mick P, Brunnemer U, Schmidmaier G, Fischer C. Functional outcome and CEUS-assessed deltoid muscle vitality after fracture-specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma. J Orthop Res 2023; 41:489-499. [PMID: 35662238 DOI: 10.1002/jor.25392] [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: 01/31/2022] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
Functional outcome after reverse-shoulder-arthroplasty (RSA) in proximal humerus fractures (PHF) depends on deltoid muscle integrity and successful reattachment of the tuberosities for best possible recovery of rotator-cuff function. In this monocentric, prospective, randomized, controlled trial we investigated whether a reverse-fracture-prosthesis (RFP) with a metaphyseal fenestrated stem achieved superior shoulder and muscle function compared to a common reverse-prosthesis (RP) design for patients with PHF. Our hypothesis was that patients with RFP may achieve a superior healing rate of the greater tuberosity (GT) compared to patients receiving RP, which translates to significantly higher clinical outcome and functional scores as well as differences in deltoid muscle microperfusion. Forty-four patients with PHF were randomized preoperatively to one of the prosthesis types in RSA between 2018 and 2020 (22 with RFP and 22 with RP) and prospectively assessed 6 months after surgery. We assessed osteointegration of the GT with radiographs 1 day and 6 months postoperatively and examined shoulder function and patient satisfaction by using established shoulder scores. A contrast-enhanced ultrasound (CEUS) examination of both shoulders was performed to quantify intramuscular blood flow and evaluate vitality of the deltoid muscle. None of the functional and psychosocial scores or radiographs and ultrasound examinations showed significant differences between the RSA designs. The constant-Murley score (p = 0.384) and active anterior-elevation-abduction, and external rotation were comparable between the RFP and RP group. Similar healing rates of the GT were observed (p = 0.655). CEUS-assessed deltoid microperfusion revealed equivalent muscle vitality for both groups (p = 0.312). Level of evidence: Level II; Randomized Controlled Trial; Treatment Study. Clinical significance: The radiographic evaluation for the investigation of the GT healing rate indicates that the proclaimed benefits of the fracture prosthesis with fenestration design might not be as great as expected.
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Affiliation(s)
- Julian Doll
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Arndt Neide
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Mick
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulf Brunnemer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany.,ARCUS Clinics, Pforzheim, Germany
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15
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Selman F, Kriechling P, Ernstbrunner L, Wieser K, Borbas P. Greater Tuberosity Fractures after RTSA: A Matched Group Analysis. J Clin Med 2023; 12:jcm12031153. [PMID: 36769800 PMCID: PMC9917577 DOI: 10.3390/jcm12031153] [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: 11/29/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Periprosthetic fractures, such as acromial and spine fractures, are known complications following implantation of reverse shoulder arthroplasty (RTSA). The entity of greater tuberosity fractures (GTF) has rarely been studied in the literature. The purpose of this study was to analyze the outcome of postoperative greater tuberosity fractures after RTSA compared to a matched control group. The main findings of this study are that a GTF after RTSA is associated with worse clinical outcome scores (mean absolute CS 50 ± 19 (p = 0.032); SSV 63% ± 26 (p = 0.022); mean force 1 kg ± 2 kg (p = 0.044)) compared with the control group (mean absolute CS 62 ± 21; SSV 77% ± 29; mean force 2 kg ± 2 kg). In terms of postoperative range of motion, the fracture group was significantly worse in terms of external rotation (17° ± 19° vs. 30° ± 19° (p = 0.029)). Internal rotation, flexion, as well as abduction of the shoulder appear to be unaffected (internal rotation GTF 4 ± 2, control group 5 ± 3 (p = 0.138); flexion GTF 102° ± 28°, control group 114° ± 27° (p = 0.160); abduction GTF 109° ± 42°, control group 120° ± 39° (p = 0.317)).
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Affiliation(s)
- Farah Selman
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Philipp Kriechling
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia
| | - Karl Wieser
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Paul Borbas
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Correspondence:
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16
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Holschen M, Körting M, Khourdaji P, Bockmann B, Schulte TL, Witt KA, Steinbeck J. Treatment of proximal humerus fractures using reverse shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical outcome and tuberosity healing? Arch Orthop Trauma Surg 2022; 142:3817-3826. [PMID: 34977963 DOI: 10.1007/s00402-021-04281-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The employment of reverse shoulder arthroplasty for dislocated proximal humerus fractures of elderly patients becomes increasingly relevant. The standard inclination angle of the humeral component was 155°. Lately, there is a trend towards smaller inclination angles of 145° or 135°. Additionally, there has been an increased focus on the lateralization of the glenosphere. This retrospective comparative study evaluates clinical and radiological results of patients treated for proximal humerus fractures by reverse shoulder arthroplasty with different inclination angles of the humeral component, which was either 135° or 155°. Additionally, a different lateral offset of the glenosphere, which was either 0 mm or 4 mm, was used. METHODS For this retrospective comparative analysis, 58 out of 66 patients treated by reverse total shoulder arthroplasty for proximal humerus fractures were included. The minimum follow-up was 24 months. Thirty (m = 3, f = 27; mean age 78 years; mean FU 35 months, range 24-58 months) were treated with a standard 155° humeral component and a glenosphere without lateral offset (group A), while 28 patients (m = 2, f = 26; mean age 79 years; mean FU 30 months, range 24-46 months) were treated with a 135° humeral component and a glenosphere with a 4 mm lateral offset (group B). We determined range of motion, Constant score, and the American Shoulder and Elbow Surgeons Shoulder score as clinical outcomes and evaluated tuberosity healing as well as scapula notching. RESULTS Neither forward flexion (A = 128°, B = 121°; p = 0.710) nor abduction (A = 111°, B = 106°; p = 0.327) revealed differences between the groups. The mean Constant Score rated 63 in group A, while it was 61 in group B (p = 0.350). There were no differences of the ASES Score between the groups (A = 74, B = 72; p = 0.270). There was an increased risk for scapula notching in group A (47%) in comparison to group B (4%, p = 0.001). Healing of the greater tuberosity was achieved in 57% of group A and in 75% of group B (p = 0.142). The healing rate of the lesser tuberosity measured 33% in group A and 71% in group B (p = 0.004). CONCLUSIONS Both inclination angles of the humeral component are feasible options for the treatment of proximal humerus fractures in elderly patients. Neither the inclination angle nor the lateral offset of the glenosphere seem to have a relevant influence on the clinical outcome. The healing rate of the lesser tuberosity was higher in implants with a decreased neck-shaft angle. There is an increased risk for scapula notching, if a higher inclination angle of the humeral component is chosen. LEVEL OF EVIDENCE III. Retrospective comparative study.
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Affiliation(s)
- Malte Holschen
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany.
- Raphaelsklinik, Loerstr. 23, 48143, Münster, Germany.
| | - Maria Körting
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | | | - Benjamin Bockmann
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kai-Axel Witt
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | - Jörn Steinbeck
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
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Tuphé P, Regas I, Sakek F, Haight H, Pluvy I, Lascar T, Obert L, Loisel F. Intra- and Inter-rater Reliability of Postoperative Radiographic Analysis of Reverse Shoulder Arthroplasty in 49 Shoulders After Proximal Humerus Fracture. Indian J Orthop 2022; 56:2013-2021. [PMID: 36310564 PMCID: PMC9561354 DOI: 10.1007/s43465-022-00716-2] [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: 03/31/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
Introduction The lateralization shoulder angle (LSA), the distalization shoulder angle (DSA) and the new "pentagon" concept are tools used in scheduled shoulder surgery to evaluate the positioning of reverse shoulder arthroplasty (RSA) implants. There is no information on the intra- and inter-rater reliability of these tools in the context of RSA for a proximal humerus fracture. The first hypothesis was the high reliability of the intra- and inter-rater analysis of the LSA and DSA angles. The second hypothesis was the reproductibility of the pentagon based on LSA and DSA analysis. Methods Forty-nine patients were evaluated retrospectively with a minimum of 2 years radiological follow-up after RSA surgery. Tuberosity healing was evaluated using an AP radiograph of the shoulder and their location analyzed within the said "pentagon" defined by the LSA/DSA angles and the maximum lengthening recommended. Results The intra-rater analysis found strong to an almost perfect agreement for the LSA and DSA. The agreement was moderate to strong for the pentagon. The inter-rater analysis found a fair agreement for the LSA and moderate agreement for the DSA and pentagon. Conclusion The LSA/DSA is used in patients undergoing RSA for glenohumeral OA. In this context, the tuberosities were intact and certain complications inherent to RSA for humeral fracture were not present. The population studied here (RSA after fracture) creates an interpretation bias due to the difficulty in analyzing tuberosity position. Level of Evidence 4, retrospective study.
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Affiliation(s)
- Pierre Tuphé
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Ines Regas
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Fiona Sakek
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Harrison Haight
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Isabelle Pluvy
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Tristan Lascar
- Orthopedic, Traumatology, and Hand Surgery Unit, Princesse Grace de Monaco Hospital, Principality of Monaco, Monaco, France
| | - Laurent Obert
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - François Loisel
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
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18
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Warnhoff M, Jensen G, Lill H, Ellwein A. [Current trends in reverse fracture arthroplasty]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:690-698. [PMID: 35861875 DOI: 10.1007/s00113-022-01211-x] [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 reliable results of reverse arthroplasty have made this the preferred treatment method for non-reconstructable proximal humeral fractures. The individual consideration of the patient and the morphological features of the fractures are essential. Computed tomography (CT) images provide crucial information on the perfusion of the humeral head relevant for the prognosis and treatment. In this context a differentiation must be made between hard and soft criteria against a reconstruction. Tuberosities should be reduced whenever possible, because reverse arthroplasty with healed tuberosities provides a better range of motion and more strength for external rotation and anteversion, less complications and longer survival rates. In recent years the trend has been towards anatomical designs of prostheses with a humeral inclination of 135°. Revision rates for primary fracture prostheses are overall low with instability as the main reason for revision surgery, followed by periprosthetic fractures and infections. Reverse fracture arthroplasty has comparable or better clinical results compared to conservative treatment, osteosynthesis for geriatric patients, hemiarthroplasty and prosthesis implantation by elective surgery. Reverse arthroplasties, which were implanted in conditions of fracture sequelae, did not achieve significantly poorer clinical outcome at mid-term follow-up and can significantly improve shoulder function.
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Affiliation(s)
- M Warnhoff
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland.
| | - G Jensen
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - H Lill
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - A Ellwein
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
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19
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Filho GDRM, Amaral MVG. Shoulder Arthroplasty for the Treatment of Proximal Humeral Fractures: Current Concepts. Rev Bras Ortop 2022; 57:529-539. [PMID: 35966425 PMCID: PMC9365482 DOI: 10.1055/s-0040-1721359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Complex proximal humeral fractures, especially in elderly patients, often require arthroplastic surgical treatment. Traditionally, shoulder hemiarthroplasty (HA) is the method of choice, resulting in long implant survival and a painless shoulder; however, shoulder HA has heterogeneous clinical outcomes related to the correct position of the implant, both in terms of height and version, and the anatomical consolidation of tuberosities. Today, reverse shoulder arthroplasties are increasingly used to treat such fractures. These techniques result in better functional outcomes compared to HAs, especially regarding anterior flexion, but implant longevity has not been established. The development of specific prosthetic humeral components for the treatment of fractures, which were recently introduced in the clinical practice, led to better clinical outcomes.
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Affiliation(s)
- Geraldo da Rocha Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Galvão Amaral
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
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20
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The clinical outcomes and tuberosity healing after reverse total shoulder arthroplasty for acute proximal humeral fracture using the turned stem tension band technique. J Orthop Sci 2022; 27:372-379. [PMID: 33551329 DOI: 10.1016/j.jos.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent studies have reported the clinical effectiveness of tuberosity healing after reverse total shoulder arthroplasty in patients with proximal humeral fractures with respect to joint stability, long-term survival, and postoperative range of motion. However, it is challenging to achieve robust fixation of the fragile bone fragments in elderly patients. This study aimed to report on the radiographic and clinical outcomes of patients who underwent reverse total shoulder arthroplasty for acute proximal humeral fractures using a Turned stem Tension Band technique-a simple suture configuration that can apply a compressive force on both tuberosities at the same time. METHODS Eighteen patients who underwent reverse total shoulder arthroplasty for complex proximal humeral fractures (age 80.4 ± 4.7 years, range 70-87 years), using our Turned stem Tension Band technique, were included in this study and evaluated postoperatively for range of motion, American Shoulder and Elbow Surgeons score, Numerical Rating Scale, and tuberosity healing, with minimum 2-years follow-up (mean 34.5 months, range 24-60 months). RESULTS At the final follow-up, mean range of motion results were active flexion, 119 ± 34°; active abduction, 116 ± 35°; active external rotation, 27 ± 12°; and active internal rotation, L3. Six of 11 (55%) patients with 4-part dislocated fractures had neurological disorders from the time of injury; of these, three patients obtained shoulder elevation under 90° at the final follow-up. The mean American Shoulder and Elbow Surgeons score was 77.3 ± 10.7, and the mean Numerical Rating Scale was 1.2 ± 0.9. Fifteen of 18 (83%) patients were satisfied with the results. The tuberosity healing rate was 100% (18 of 18). CONCLUSIONS The Turned stem Tension Band technique in reverse total shoulder arthroplasty for proximal humeral fractures provides a robust fixation, regardless of the fracture pattern, which results in a high tuberosity healing rate.
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VanHelmond TA, Iyer H, Lung BE, Kashanchi KI, Pearl M, Komatsu DE, Wang ED. Clinical outcomes following reverse total shoulder arthroplasty with tuberosity excision for treatment of proximal humerus fractures: a case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:56-63. [PMID: 37588277 PMCID: PMC10426692 DOI: 10.1016/j.xrrt.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular treatment option for complex 3- and 4-part proximal humerus fractures in elderly patients. The literature has demonstrated that tuberosity repair likely improves postoperative range of motion (ROM). However, the difference between tuberosity repair and excision may not be appreciable to patients in their day-to-day lives. This case series reports both objective and subjective clinical outcomes of patients who underwent RTSA with tuberosity excision for proximal humerus fractures. Methods We reviewed the records of 41 patients who underwent RTSA for complex 3- and 4- part proximal humerus fractures. All RTSA procedures were performed by a single surgeon between 2014 and 2017. All patients underwent RTSA with extended proximal stem cementation and tuberosity excision. Postoperative outcomes were measured at least 2 years postoperatively and included ROM measurements for forward flexion, internal rotation, abduction, and external rotation. Patient-reported outcome measures included Simple Shoulder Test scores, American Shoulder and Elbow Surgeons scores, and Penn Shoulder Score were also reported. Results In this case series, we report on 41 patients, 33 females and 8 males. Objective measurements of ROM for forward flexion, abduction, and external rotation were 125, 95, and 36 degrees, respectively. On average, patients had an internal rotation score of 2.06 and were able to get their thumb to their iliac crest. Clinical outcome scores of these patients were 9.11, 77.79, and 74.12 for the Simple Shoulder Test, American Shoulder and Elbow Surgeons, and Penn Shoulder Score, respectively. Strength of the deltoid was 5/5 in all 41 patients. Conclusions When compared with the current literature, our tuberosity excision patients demonstrated deficits in forward flexion and abduction, with preserved external rotation. Our clinical outcome score measurements were consistent with clinical outcome measurements from previous studies of patients undergoing RTSA with tuberosity repair. We believe that tuberosity excision may be a reasonable and simpler surgical option for surgeons with lower volumes of shoulder fractures and patients with multiple comorbidities and higher surgical risk, owing to the similarity of outcome scores between our cohort and previous tuberosity repair groups.
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Affiliation(s)
- Taylor A. VanHelmond
- Florida Atlantic University School of Medicine Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Hari Iyer
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brandon E. Lung
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Kevin I. Kashanchi
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Matthew Pearl
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Stony Brook University School of Medicine, Department of Orthopedic Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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Joseph EG, Krichmar A, Haider MN, Duquin TR. Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Using Uncemented Stems, a Single Center Study. J Shoulder Elb Arthroplast 2022; 6:24715492221127686. [PMID: 36157844 PMCID: PMC9500255 DOI: 10.1177/24715492221127686] [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: 05/11/2022] [Revised: 08/21/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the clinical, functional, radiographic, and survival outcomes in patients undergoing reverse total shoulder arthroplasty (RSA) with uncemented stem fixation for proximal humerus fractures. Materials and Methods This is a retrospective cohort study that evaluated a consecutive series of patients with proximal humerus fractures undergoing RSA. Clinical data, radiographs, and re-operation rates were reviewed in patients selected for uncemented stem fixation. The same parameters were compared to the remainder of the cohort undergoing cemented stem fixation. Results The uncemented group (n = 16, median total follow-up = 108 weeks) and cemented group (n = 12, median total follow-up = 223 weeks, p = 0.110) did not differ statistically in pre-operative demographic, post-operative outcomes or incidence of complications. Two patients (12.5%) in the uncemented group required a reoperation (Week 52 and 180) versus none in the cemented group. Conclusion Uncemented stem fixation in RSA for proximal humerus fractures does not yield worse results than cemented stem fixation in properly selected patients. Prospective non-inferiority trials comparing outcomes are recommended.
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Affiliation(s)
- Elias G Joseph
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Aleksandr Krichmar
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mohammad Nadir Haider
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Thomas R Duquin
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Reverse total shoulder arthroplasty for fractures and posttraumatic sequelae is associated with inferior forward elevation strength: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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He SK, Liao JP, Guo JH, Huang FG. Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis. Front Surg 2021; 8:616104. [PMID: 34957194 PMCID: PMC8695904 DOI: 10.3389/fsurg.2021.616104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/31/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Reverse shoulder arthroplasty (RSA) is becoming popular in the treatment of complex proximal humeral fractures (PHFs). Greater tuberosity healing may influence functional outcomes and range of motion (ROM) of shoulder after RSA. In addition, the design of prosthesis may impact the healing rate of greater tuberosity. The purpose of this study is to know: (1) does the healing of greater tuberosity affect the functional outcomes and ROM of shoulder? and (2) does the design of prosthesis affect the healing rate of greater tuberosity? Materials and Methods: PubMed, Ovid/Embase, and the Cochrane Library were searched for studies comparing the clinical outcomes between the healed groups and the non-healed groups after RSA. Results: For functional outcomes, the results showed that the healed group had better Constant scores (CSs) (p < 0.0001). For ROM, the healed group showed better flexion (p < 0.0001), abduction (p = 0.02), and external rotation (p < 0.00001) of shoulder. For the design of prosthesis, the mean healing rate of greater tuberosity (82.7%) in patients with fracture-dedicated prosthesis was higher than those (63.0%) in patients with standard prosthesis. Subgroup analyses showed that the CS (p = 0.12) and abduction (p = 0.96) of patients using fracture-dedicated prostheses were not different between the healed groups and the non-healed groups. Meta-regression showed that there was no significant relationship between the design of prosthesis and CS (p = 0.312), flexion (p = 0.422), or external rotation (p = 0.776). Conclusion: Our meta-analysis showed that the healed groups could obtain better functional outcomes and ROM than the non-healed groups. In addition, fracture-dedicated prostheses promoted the healing rate of greater tuberosity. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276, PROSPERO: CRD42020157276.
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Affiliation(s)
- Shu-Kun He
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing-Ping Liao
- School of Nursing, Peking University, Beijing, China.,Institute of Mental Health, The Sixth Hospital, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health, Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing, China
| | - Jin-Hai Guo
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fu-Guo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Dolci A, Melis B, Verona M, Capone A, Marongiu G. Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review. Geriatr Orthop Surg Rehabil 2021; 12:21514593211059865. [PMID: 34900387 PMCID: PMC8664304 DOI: 10.1177/21514593211059865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The reverse shoulder arthroplasty is nowadays a treatment option for a variety of shoulder problems. As its incidence rose, also the number of complications increased, including intraoperative fractures. Significance We performed a systematic review and critical analysis of the current literature following the PRISMA guidelines. Our purpose was to: 1) determine incidence, causes, and characteristics of intraoperative fractures; 2) evaluate their current treatment options, possible related complications, reoperation rates, and the patients’ outcome; and 3) determine the overall incidence of each complication related to reverse shoulder arthroplasty. The articles were selected from PubMed medical database in April 2020 using a comprehensive search strategy. Rayyan software was used to support the selection process of the records. A descriptive and critical analysis of the results was performed. Results The study group included a total of 13,513 reverse shoulder arthroplasty procedures. The total number of complications was 1647 (rate 12.1%). The most common complication was dislocation (340 cases, rate 2.5%). Forty-six studies reported a total of 188 intraoperative fractures among the complications (rate 1.4%). The intraoperative fracture rate was 2.9% and 13.6% in primary and revision settings, respectively. There were 136 humeral fractures, 60% of them occurred in revision RSAs, during the removal of the previous implant, and involved the shaft in the majority of cases (39%). Glenoid fractures were 51 and occurred mostly during the reaming of the glenoid. We observed 7 further related complications (rate of 4%) and 3 reoperations (rate of 1.5%). The outcome was satisfactory in the majority of cases. Conclusions A comprehensive review on intraoperative fractures in reverse shoulder arthroplasties is presented. Results suggest favorable outcomes for all treatment methods, with a modest further complication rate. This investigation may aid in the treatment decision-making for these complications.
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Affiliation(s)
- Andrea Dolci
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Barbara Melis
- Orthopaedic and Sport Trauma Unit, Casa di Cura Policlinico Città di Quartu, Quartu Sant'Elena, Italy
| | - Marco Verona
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Antonio Capone
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Giuseppe Marongiu
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Rev 2021; 6:1097-1108. [PMID: 34909228 PMCID: PMC8631242 DOI: 10.1302/2058-5241.6.210039] [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] [Indexed: 11/05/2022] Open
Abstract
The initial reverse shoulder arthroplasty (RSA), designed by Paul Grammont, was intended to treat rotator cuff tear arthropathy in elderly patients. In the early experience, high complication rates (up to 24%) and revision rates (up to 50%) were reported.The most common complications reported were scapular notching, whereas clinically more relevant complications such as instability and acromial fractures were less commonly described.Zumstein et al defined a 'complication' following RSA as any intraoperative or postoperative event that was likely to have a negative influence on the patient's final outcome.High rates of complications related to the Grammont RSA design led to development of non-Grammont designs, with 135 or 145 degrees of humeral inclination, multiple options for glenosphere size and eccentricity, improved baseplate fixation which facilitated glenoid-sided lateralization, and the option of humeral-sided lateralization.Improved implant characteristics combined with surgeon experience led to a dramatic fall in the majority of complications. However, we still lack a suitable solution for several complications, such as acromial stress fracture. Cite this article: EFORT Open Rev 2021;6:1097-1108. DOI: 10.1302/2058-5241.6.210039.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick J. Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Suroto H, De Vega B, Deapsari F, Prajasari T, Wibowo PA, Samijo SK. Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:941-955. [PMID: 34760293 PMCID: PMC8559569 DOI: 10.1302/2058-5241.6.210049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies.We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach.Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively).RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049.
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Affiliation(s)
- Heri Suroto
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
- These authors contributed equally to this work
| | - Brigita De Vega
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- These authors contributed equally to this work
| | - Fani Deapsari
- Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tabita Prajasari
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
| | - Pramono Ari Wibowo
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
| | - Steven K. Samijo
- Department of Orthopaedics and Traumatology Zuyderland Medisch Centrum, Heerlen, the Netherlands
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Boyer P, Couffignal C, Bahman M, Mylle G, Rousseau MA, Dukan R. Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate. INTERNATIONAL ORTHOPAEDICS 2021; 45:2917-2926. [PMID: 34554308 DOI: 10.1007/s00264-021-05217-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. METHODS A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n = 49) or LP (n = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. RESULTS Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs. 1.9 (± 1.7), p = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) (p = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). CONCLUSION Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.
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Affiliation(s)
- Patrick Boyer
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Camille Couffignal
- Clinical Research, Biostatistics and Epidemiology Department, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Mohammad Bahman
- Alrazi Hospital, University of Kuwait, Al Sabah Medical Area, Kuwait, Kuwait
| | - Guy Mylle
- Clinique Hartmann, Neuilly Sur Seine, France
| | - Marc-Antoine Rousseau
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Ruben Dukan
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France.
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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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Jo O, Borbas P, Grubhofer F, Ek ET, Pullen C, Treseder T, Ernstbrunner L. Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures. J Clin Med 2021; 10:4146. [PMID: 34575254 PMCID: PMC8468418 DOI: 10.3390/jcm10184146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/04/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.
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Affiliation(s)
- Olivia Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
| | - Christopher Pullen
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Thomas Treseder
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
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Siebenbürger G, Fleischhacker E, Gleich J, Helfen T, Böcker W, Ockert B. Supraspinatus Tenotomy in Reverse Shoulder Arthroplasty for Fractures: A Comparative Cohort Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211019973. [PMID: 34285822 PMCID: PMC8267020 DOI: 10.1177/21514593211019973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/29/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the functional and radiographic outcome in patients with reverse total shoulder arthroplasty (RSA) for displaced proximal humeral fractures (PHF) with or without tenotomy of the supraspinatus tendon. Methods Between June 2011 and June 2018, 159 patients (age >65 years) with a displaced proximal humeral fracture underwent reverse total shoulder arthroplasty (Grammont design) in a single-center study and were longitudinally followed up. In all cases, the tuberosities were attached to the prosthesis in a standardized procedure. Functional outcome, range of motion as well as tuberosity integration, resorption and displacement were assessed at final follow-up. Outcomes were compared between patients that underwent RSA in combination with tenotomy of the supraspinatus (ST) and patients that underwent RSA without supraspinatus tenotomy (NT). Results At a mean follow up of 22.2 ± 16.4 months 76 patients (mean age 77.1 ± 7.2 years, 83% women) could be evaluated (follow-up rate 47.8%). There were no statistically significant differences between the ST (n = 29) and NT groups (n = 47) in tuberosity integration, resorption </≥50%, or displacement (p = 0.99/0.31/0.7/0.99). Functional outcome was better in ST group (Constant score 76.2 ± 5.9 vs. 64.5 ± 12.8; p < 0.05) especially regarding mean active external rotation (>20°: 65.5% vs. 14.9%, p < 0.05) and active abduction (>120°: 89.7% vs. 21.3%, p < 0.05). Tuberosity integration (ST and NT together: n = 34) showed better functional results than resorption or displacement (p < 0.05). Conclusions Tenotomy of the supraspinatus tendon in RSA for displaced PHF leads to similar radiographic results regarding tuberosity integration, resorption and displacement but better functional outcome with regard to range of motion. Level of Evidence III.
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Affiliation(s)
- Georg Siebenbürger
- Shoulder and Elbow Service, Department of General, Trauma and Reconstructive Surgery, Munich University Hospitals, Ludwig-Maximilians-University, Germany
| | - Evi Fleischhacker
- Shoulder and Elbow Service, Department of General, Trauma and Reconstructive Surgery, Munich University Hospitals, Ludwig-Maximilians-University, Germany
| | - Johannes Gleich
- Shoulder and Elbow Service, Department of General, Trauma and Reconstructive Surgery, Munich University Hospitals, Ludwig-Maximilians-University, Germany
| | - Tobias Helfen
- Shoulder and Elbow Service, Department of General, Trauma and Reconstructive Surgery, Munich University Hospitals, Ludwig-Maximilians-University, Germany
| | - Wolfgang Böcker
- Shoulder and Elbow Service, Department of General, Trauma and Reconstructive Surgery, Munich University Hospitals, Ludwig-Maximilians-University, Germany
| | - Ben Ockert
- Shoulder and Elbow Service, Department of General, Trauma and Reconstructive Surgery, Munich University Hospitals, Ludwig-Maximilians-University, Germany
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Sabah Y, Decroocq L, Gauci MO, Bonnevialle N, Lemmex DB, Chelli M, Valenti P, Boileau P. Clinical and radiological outcomes of reverse shoulder arthroplasty for acute fracture in the elderly. INTERNATIONAL ORTHOPAEDICS 2021; 45:1775-1781. [PMID: 33893521 DOI: 10.1007/s00264-021-05050-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The goal of this study was to assess the clinical outcomes associated with anatomic healing of the greater tuberosity in patients treated for proximal humerus fractures with reverse shoulder arthroplasty. Our hypothesis was that anatomic healing of the greater tuberosity leads to less complications and better functional outcomes. METHODS RESULTS: Patients from the GT+ group presented better functional outcomes than the GT- group in all evaluated outcomes. Mean constant score was 61 ± 14 versus 56 ± 15, and the subjective shoulder value (SSV) was 77 ± 14 versus 64 ± 21 (p < 0.001). Forward elevation was 128° ± 28° versus 107° ± 30° and external rotation was 23° ± 17° versus 14° ± 17° (p < 0.001). Twenty patients presented with at least one prosthetic dislocation (7 GT+ vs 13 GT-) while nine patients were revised for humeral loosening (1 GT+ vs 8 GT-). The use of a fracture specific humeral stem was associated with a higher rate of greater tuberosity healing. CONCLUSIONS Non-anatomic healing of the greater tuberosity was associated with a higher dislocation and humeral loosening rate. Anatomic healing of the greater tuberosity lead to better functional outcomes, less humeral-sided complications, and fewer re-operations.
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Affiliation(s)
- Yann Sabah
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France.
| | - Lauryl Decroocq
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France
| | | | | | | | - Mikael Chelli
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France
| | | | - Pascal Boileau
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France
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Adeyemo A, Bertha N, Perry KJ, Updegrove G. Implant Selection for Proximal Humerus Fractures. Orthop Clin North Am 2021; 52:167-175. [PMID: 33752838 DOI: 10.1016/j.ocl.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Proximal humerus fractures (PHF) are a common orthopedic injury; however, their treatment remains largely controversial with evidence supporting a wide array of treatments. Although many injuries can be treated nonoperatively, there has been much debate about surgical management of PHF. A detailed review of the literature was performed relative to operative management options specifically related to implant choices. Although no definitive answers are available regarding best practice, there is literature to guide operative decision-making and implant selection based on both patient- and surgeon-specific factors.
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Affiliation(s)
- Adeshina Adeyemo
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Nicholas Bertha
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Kevin J Perry
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Gary Updegrove
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA.
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Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:681-687. [PMID: 33420880 DOI: 10.1007/s00264-020-04928-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) is often indicated in elderly patients with displaced proximal humerus fractures (PHF). The rate of greater tuberosity (GT) healing varies from 37 to 90% in this population. The aim of this study was to assess greater and lesser tuberosity (LT) fixation and healing on CT scan after RSA for PHF. Our hypothesis was that both GT and LT healing leads to better functional results after RSA for fracture. METHODS Our retrospective cohort consisted of 28 patients treated with an RSA for a four-part PHF during the inclusion period. The mean age at surgery was 77 years. Clinical examination and CT scan were performed at a minimum one year follow-up to assess tuberosity position and healing. RESULTS The GT healed in 22 patients (78.5%), the LT in 24 patients (87.5%) and both tuberosities were healed in 20 patients (71.5%). Constant score was significantly improved with GT, LT and both tuberosity healing (p = 0.05, p = 0.04 and p = 0.02 respectively). Motion in anterior elevation was improved with GT and both tuberosity healing (p = 0.01 and p = 0.04 respectively). Motion in external rotation was improved with GT and both tuberosity healing (p = 0.01 and p = 0.02 respectively). CONCLUSION GT and LT healing was associated with better functional results and active motion. Anatomical reduction and consolidation of both tuberosities is beneficial with a cumulative effect for functional recovery.
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Boileau P, Seeto BL, Clowez G, Gauci MO, Trojani C, Walch G, Chelli M. SECEC Grammont Award 2017: the prejudicial effect of greater tuberosity osteotomy or excision in reverse shoulder arthroplasty for fracture sequelae. J Shoulder Elbow Surg 2020; 29:2446-2458. [PMID: 33190752 DOI: 10.1016/j.jse.2020.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim was to evaluate risk factors for complications, revision, and mid- to long-term outcomes after reverse shoulder arthroplasty (RSA) implanted for proximal humeral fracture sequelae (PHFS). METHODS The radiographs of 98 patients (mean age, 68 years) who underwent RSA for the treatment of PHFS were reviewed at a minimum 5-year follow-up. PHFS were divided into 4 types according to the Boileau classification: type 1 (46 cases), type 2 (6 cases), type 3 (12 cases), and type 4 (34 cases). The tuberosities underwent osteotomy in 28 cases and excision in 12 (all type 3 or 4 PHFS). The mean follow-up period was 8.4 years (range, 5-14 years). RESULTS The functional results and rate of RSA survival without revision (85% vs. 100% at 10 years, P = .007) were significantly lower for types 3 and 4 vs. types 1 and 2. Overall, our findings showed that RSA for PHFS is not the panacea that surgeons once believed: At a mean follow-up of 8.5 years (range, 5-14 years), 59% of the patients in our series had fair or poor results. Patients who underwent tuberosity osteotomy or excision had lower functional results (adjusted Constant score, 69% vs. 88%; P < .001), more postoperative complications (32% vs. 9%, P = .003), and a higher revision rate (15% vs. 2%, P = .017). Patients who underwent tuberosity osteotomy or excision at the time of RSA were at risk of postoperative prosthetic instability and humeral stem loosening. The absence of the greater tuberosity at last radiographic follow-up was predictive of higher rates of complications and revisions, as well as a poorer final outcome. Previous fracture fixation was associated with a higher rate of complete tuberosity resorption (56% vs. 33%, P = .026) and with higher rates of postoperative complications (27% vs. 13%, P = .099) and reinterventions (17% vs. 2%, P = .018). CONCLUSION The functional results and rates of complications and revision depend on the type of fracture sequelae and tuberosity management. Patients with more severe (type 3 and 4) fracture sequelae who undergo tuberosity osteotomy or excision are at risk of having a poorer functional result and higher rates of complications and revision with lower survival. Previous fracture fixation is also a prejudicial factor.
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Affiliation(s)
- Pascal Boileau
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France.
| | - Brian L Seeto
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | - Gilles Clowez
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | - Marc-Olivier Gauci
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | - Christophe Trojani
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | | | - Mikaël Chelli
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
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Tuberosity Repair in Reverse Total Shoulder Arthroplasty for Fracture Using a Stem-based Double-row Repair: A Cadaveric Biomechanical Study. J Am Acad Orthop Surg 2020; 28:e1059-e1065. [PMID: 32195827 DOI: 10.5435/jaaos-d-19-00667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/23/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The optimal tuberosity repair method in reverse total shoulder arthroplasty for fracture is unknown. METHODS Eight matched pairs of cadaver shoulders were randomly assigned to a stem-based tuberosity repair technique or a nonstem-based repair (Boileau technique) and mechanically tested with a 10 kN load cell. Cyclic loading was performed between 10 and 100 N for 500 cycles at 1 Hz, followed by static pull to failure at 33 mm/s. Ultimate load was determined from the maximum load reached during the pull to failure. A paired Student t-test was used to compare the means of the ultimate load and average cyclic displacement of the two sample groups. RESULTS The ultimate load to failure for the stem-based tuberosity repair technique was significantly higher than the nonstem-based technique (668 ± 164 N versus 483 ± 67 N; P = 0.032). The average cyclic displacement for the stem-based tuberosity repair technique was significantly less than the nonstem-based technique 0 (0.83 ± 0.67 mm versus 3.36 ± 2.36 mm; P = 0.017). CONCLUSION The stem-based tuberosity repair technique afforded higher ultimate load to failure with less average cyclic displacement than the nonstem-based technique. Consideration to the stem-based technique should be given when performing a tuberosity repair in the setting of reverse total shoulder arthroplasty for fracture. LEVEL OF EVIDENCE Level III.
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Fortané T, Beaudouin E, Lateur G, Giraudo P, Kerschbaumer G, Boudhissa M, Tonetti J. Tuberosity healing in reverse shoulder arthroplasty in traumatology: Use of an offset modular system with bone graft. Orthop Traumatol Surg Res 2020; 106:1113-1118. [PMID: 32807699 DOI: 10.1016/j.otsr.2020.04.018] [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: 12/18/2019] [Revised: 03/13/2020] [Accepted: 04/30/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) has become a common treatment in displaced proximal humeral fracture (PHF) in elderly patients due to inconstant results with osteosynthesis or hemiarthroplasty. RSA allows a good anterior elevation but rotational results are more random and depend on tuberosity healing. HYPOTHESIS Use of an offset modular system (OMS) on the prothesis improve tuberosity healing and functional results. MATERIAL AND METHODS This retrospective cohort analysed radiological and clinical outcomes at least one year after the use of RSA Humelock II Reversed (Fx Solutions) after a displaced PHF Neer 3 or 4 in patients over 70 years. The first criterion was tuberosity healing with or without the use of the OMS device on radiographs. The second criterion was a clinical analysis of active range of motion (ROM), anterior elevation (AAE), external and internal rotations (ER, IR), Constant, DASH, SSV, VAS scores according to tuberosity healing. We also analysed radiological and clinical complications. RESULTS We analysed from November 2013 to May 2018 thirty-four RSA. Mean age was 78±5,7 years, mean follow up was 18±7,2 months and the mean tuberosity healing rate was 79%. Mean ROM were: 117±24 (AAE), 18̊±18 (ER) and L2 (IR). On the first analysis, healing tuberosity with cage was present on 24 (92%) patients versus 3 (37,5%) without (p<0,005). The second analysis showed a non-significant improvement on ER, IR, Constant, DASH and SSV. Complications found were three removal of prothesis after infection, one axillary nerve lesion, one ulnar paraesthesia and one humeral loosening. CONCLUSION The use of the OMS cage allows a better consolidation of tuberosities in a significant way but no significant clinical effects was highlighted due to a small patient number in the study. LEVEL OF EVIDENCE level III, retrospective cohort.
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Affiliation(s)
- Thibaut Fortané
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble North University Hospital, 38700 La Tronche, France.
| | - Emmanuel Beaudouin
- Department of Orthopaedic Surgery and Sport Traumatology, Hospital Center Metropole Savoie, 73000 Chambéry, France
| | - Gabriel Lateur
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South University Hospital, 38130 Échirolles, France
| | - Pedro Giraudo
- Department of Orthopaedic Surgery and Sport Traumatology, Hospital Center Metropole Savoie, 73000 Chambéry, France
| | - Gael Kerschbaumer
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble North University Hospital, 38700 La Tronche, France
| | - Mehdi Boudhissa
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble North University Hospital, 38700 La Tronche, France
| | - Jérôme Tonetti
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble North University Hospital, 38700 La Tronche, France
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Shah SS, Roche AM, Sullivan SW, Gaal BT, Dalton S, Sharma A, King JJ, Grawe BM, Namdari S, Lawler M, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int 2020; 5:121-137. [PMID: 33554177 PMCID: PMC7846704 DOI: 10.1016/j.jseint.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
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Affiliation(s)
- Sarav S. Shah
- American Shoulder and Elbow Surgeons (ASES) Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
- Corresponding author: Sarav S. Shah, MD, 125 Parker Hill Ave, Boston, MA 02120, USA.
| | | | | | - Benjamin T. Gaal
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Stewart Dalton
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Arjun Sharma
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph J. King
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Brian M. Grawe
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Surena Namdari
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Macy Lawler
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Thomas W. Wright
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Kyle Flik
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Randall J. Otto
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Jones
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Andrew Jawa
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Peter McCann
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph Abboud
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Gabe Horneff
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Glen Ross
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Friedman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Douglas Boardman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
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Klug A, Harth J, Hoffmann R, Gramlich Y. Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:1796-1803. [PMID: 32279985 DOI: 10.1016/j.jse.2020.01.073] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/05/2020] [Accepted: 01/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, there is a lack of consensus regarding the type of surgical treatment for complex proximal humeral fractures (PHFs) in elderly patients, especially between joint preservation and joint replacement techniques. MATERIALS AND METHODS We matched 60 patients (aged 73.2 ± 6.4 years) with complex PHFs in terms of sex, age, and Charlson Comorbidity Index, who underwent locking-plate open reduction-internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) (2011-2017). Postoperative range of motion and functional outcome were assessed using the American Shoulder and Elbow Surgeons shoulder score, Oxford Shoulder Score, Constant-Murley score, and Disabilities of the Arm, Shoulder and Hand score at a mean follow-up of 49 months (ORIF group) and 38 months (RSA group). Complications and unplanned revision surgery were recorded, and all radiographs were analyzed. RESULTS ORIF resulted in numerically, although not statistically significantly, greater mean shoulder motion vs. RSA. Significantly better outcome was reported for the Oxford Shoulder Score (P = .034) and Disabilities of the Arm, Shoulder and Hand score (P = .026) in the ORIF group, although no significant differences were observed in the American Shoulder and Elbow Surgeons shoulder score and Constant-Murley score. The complication rate (30% vs. 10%) and revision rate (20% vs. 3%) were significantly higher in the ORIF group (P = .028), with patients who had complications or required revision having worse functional results. CONCLUSION Favorable results are achievable through both angular-stable plating and RSA. Although ORIF may be associated with a superior functional outcome, exceeding the minimal clinically important difference, RSA was linked to significantly fewer complications and revisions.
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Affiliation(s)
- Alexander Klug
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany.
| | - Jasmin Harth
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Yves Gramlich
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
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Cheah JW, Baldwin EL, O'Donnell JA, Pereira G, Vance DD, Lassiter TE, Anakwenze OA. Rotator cuff to deltoid and pectoralis tendon to anatomic neck distances: methods for anatomic restoration of humeral height and tuberosity position in proximal humerus fractures for operative fixation and arthroplasty. JSES Int 2020; 4:869-874. [PMID: 33345227 PMCID: PMC7738573 DOI: 10.1016/j.jseint.2020.07.015] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction Proper anatomic tuberosity reduction and restoration of humeral height during surgical treatment of proximal humerus fractures leads to fewer complications and better outcomes. In the presence of significant displacement and comminution in proximal humerus fractures, the assessment of the correct tuberosity position and humeral height can be challenging. The goal of this cadaveric study was to provide new and useful measurements for intraoperative guidance of proper tuberosity position and humeral height when treating proximal humerus fractures with open reduction internal fixation, anatomic hemiarthroplasty, or reverse total shoulder arthroplasty. Methods A total of 28 cadaveric shoulders were dissected with a deltopectoral approach. The distance between the insertion of the supraspinatus tendon and the superior aspect of the deltoid tendon was measured (cuff to deltoid distance [CDD]). Secondly, the distance between the superior aspects of the pectoralis major tendon to the medial aspect of the anatomic neck (PND) was measured. Further, we sought to determine if these measurements would correlate to patient height and differ between gender. Results The average age of the donors was 65.3 years (64% male). The CDD and PND were 87.6 ± 10.6 and 16.6 ± 6.9 mm, respectively (mean ± standard deviation). There were no differences between females and males for the CDD (86.9 ± 9.4 vs. 87.2 ± 15.2 mm, P = .96) and PND (16.3 ± 9.1 vs. 17.1 ± 5.9 mm, P = .76). There was no correlation between the cadaver height and CDD (R2 = 0.1) and PND (R2 = 0.3). Discussion In this study, we describe 2 new measurement tools that can readily be applied intraoperatively during surgical treatment of proximal humerus fractures to aid in tuberosity reduction and humeral height assessment. These measurements were found to be independent of patient height and gender and can be used as a reference tool for most patients.
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Affiliation(s)
- Jonathan W Cheah
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Edward L Baldwin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey A O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gregory Pereira
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Danica D Vance
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Raleigh, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Schmalzl J, Jessen M, Holschen M, Cohen BC, Steinbeck J, Lehmann LJ, Denard PJ. Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:909-916. [DOI: 10.1007/s00590-020-02649-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
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Manzi JE, Ruzbarsky JJ, Rauck RC, Gulotta LV, Dines JS, Dines DM. Failed Proximal Humerus Osteosynthesis Using Intramedullary Fibular Strut Allograft Conversion to Reverse Shoulder Arthroplasty. Tech Hand Up Extrem Surg 2020; 24:7-12. [PMID: 31436758 DOI: 10.1097/bth.0000000000000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Comminuted proximal humerus fractures are more frequently being treated utilizing an intramedullary fibular strut allograft to assist with open reduction internal fixation. Although this technique has led to improved outcomes, avascular necrosis, rotator cuff failure, and/or prominent hardware may still occur necessitating conversion to reverse shoulder arthroplasty. The presence of an intramedullary strut allograft makes this conversion technically demanding and creates certain potential complications unique to this group. This manuscript details the conversion of a proximal humerus open reduction internal fixation with a fibular strut allograft to reverse shoulder arthroplasty including presurgical workup, surgical techniques, and pitfalls for undertaking this increasingly common scenario.
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Schoch BS, Vasilopoulos T, LaChaud G, Wright TW, Roche C, King JJ, Werthel JD. Optimal glenosphere size cannot be determined by patient height. J Shoulder Elbow Surg 2020; 29:258-265. [PMID: 31500985 DOI: 10.1016/j.jse.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenosphere size remains 1 surgeon-controlled variable that can affect patient outcomes following reverse shoulder arthroplasty (RSA). There remains no objective criterion to guide surgeons in choosing glenosphere size. This study's purpose was to evaluate range of motion (ROM) as a function of patient height and glenosphere size to determine the optimal glenosphere size based on patient height. METHODS We retrospectively reviewed 589 primary RSAs from a multicenter shoulder arthroplasty database of a single RSA system with multiple glenosphere sizes. Shoulders were separated into groups based on glenosphere size (38 or 42 mm). Predictive accuracy was calculated in relation to height and sex for predicting glenosphere size. Improvements in active ROM and patient-reported outcome measures (PROMs) were compared based on glenosphere size as a function of height. RESULTS Logistic regression analysis demonstrated a strong association of height and sex with surgeon selection of glenosphere size, with shorter heights preferentially treated with 38-mm glenospheres and taller heights with 42-mm glenospheres. There were no statistically significant interaction effects of glenosphere size and height on improvements in ROM or PROMs. These results indicate that for a given glenosphere size, there is not an optimal height range to maximize improvements in postoperative outcome measures. DISCUSSION Height and sex are highly correlated with a surgeon's choice of glenosphere size. However, on the basis of improvements in ROM and PROMs, no recommendation can be made for surgeons to select a particular glenosphere size based on a patient's height. Surgeons should consider other variables when selecting a glenosphere size.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Terrie Vasilopoulos
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Gregory LaChaud
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | - Joseph J King
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Jean David Werthel
- Department of Orthopedic Surgery, Hopital Ambroise Paré, Boulogne-Billancourt, France
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Sabesan VJ, Lima DJL, Yang Y, Stankard MC, Drummond M, Liou WW. The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis. J Shoulder Elbow Surg 2020; 29:347-354. [PMID: 31606318 DOI: 10.1016/j.jse.2019.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lack of greater tuberosity (GT) healing in proximal humerus fractures has been negatively correlated with outcomes for hemiarthroplasty; however, there is still debate regarding the effects of GT healing in reverse shoulder arthroplasty (RSA). Our goal was to examine the effects of GT healing using a kinematic finite element analysis (FEA) model. MATERIAL AND METHODS Computer-aided design models of a medialized glenoid with a lateralized humerus (MGLH) RSA design were uploaded into an FEA shoulder model in 2 different configurations: healed greater tuberosity (HGT) and nonunion greater tuberosity (NGT). Deltoid muscle forces and joint reaction forces (JRFs) on the shoulder were calculated during abduction (ABD), forward flexion (FF), and external rotation (ER). RESULTS Force magnitude of the anterior, middle, and posterior deltoid muscle as well as JRFs modeled in both GT scenarios were similar for ABD (muscle forces P = .91, P = .75, P = .71, respectively; and JRF P = .93) and for FF (muscle forces P = .89, P = .83, P = .99, respectively; and JRF P = .90). For ER, the force magnitude between 2 GT settings showed statistically significant differences (HGT: 9.51 N vs. NGT: 6.13 N) (P < .001). Likewise, during ER, JRFs were different, and the NGT group showed a steep drop in JRF after 10° of ER (HGT: 28.4 N vs. NGT: 18.38 N) (P < .001). CONCLUSION GT healing does not seem to impact RSA biomechanics during abduction or forward flexion; however, it does affect biomechanics during external rotation. Overall orthopedic surgeons can expect good results for patients after RSA even with poor GT healing.
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Affiliation(s)
- Vani J Sabesan
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Diego J L Lima
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Yang Yang
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI, USA
| | - Matthew C Stankard
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Mauricio Drummond
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - William W Liou
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI, USA
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Bonnevialle N, Ohl X, Clavert P, Favard L, Frégeac A, Obert L, Chantelot C, Gallinet D, Boileau P. Should the supraspinatus tendon be excised in the case of reverse shoulder arthroplasty for fracture? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:231-235. [PMID: 31586235 DOI: 10.1007/s00590-019-02572-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/26/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE In the case of reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs) with tuberosity reconstruction, it is unclear whether the supraspinatus tendon continues to play a role. The aim of this study was to evaluate the clinical and radiological outcomes of RSA for PHFs in a large cohort of elderly patients and compare the results in the case of supraspinatus excision or preservation. METHODS In this retrospective multicentre study, 150 patients (mean age 77 years, 93% female) were reviewed and radiographed with a minimum follow-up of 24 months. The same Grammont prosthetic design was used in all cases (inclination angle 155°, non-lateralised glenosphere). Patients were divided into two groups: Group A (n = 117) underwent supraspinatus excision and Group B supraspinatus preservation (n = 33). Complications were recorded, and shoulder function, active mobility and subjective results were assessed. RESULTS At a mean follow-up of 59 months, there was no statistical difference in the complication rate (6% vs. 6.8%, p = 1), mean Constant score (61 points vs. 59 points, p = 0.52), simple shoulder value (74% vs. 73.9%, p = 0.9), active anterior elevation (125° vs. 128°, p = 0.45) and internal rotation (4.9 points vs. 4.1 points, p = 0.2). However, mean active external rotation was better in Group A (22° vs. 13°, p = 0.01). The greater tuberosity healing rate in satisfactory position did not differ statistically between the groups (68% vs. 55%, p = 0.14). CONCLUSION In the case of RSA with tuberosity reconstruction for acute PHFs, there is no clear evidence that supraspinatus preservation is advantageous.
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Affiliation(s)
- Nicolas Bonnevialle
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France.
| | - Xavier Ohl
- Orthopaedic Department, University Hospital, Reims, France
| | | | - Luc Favard
- Trousseau University Hospital, Tours, France
| | - Anne Frégeac
- AERCOT, iULS, University Hospital Pasteur, Nice, France
| | | | | | | | - Pascal Boileau
- Department of Orthopaedic Surgery, iULS, University of Nice Sophia-Antipolis, Nice, France
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Klug A, Wincheringer D, Harth J, Schmidt-Horlohé K, Hoffmann R, Gramlich Y. Complications after surgical treatment of proximal humerus fractures in the elderly-an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. J Shoulder Elbow Surg 2019; 28:1674-1684. [PMID: 31056394 DOI: 10.1016/j.jse.2019.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/10/2019] [Accepted: 02/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, there is a lack of consensus regarding surgical treatment recommendations for complex proximal humerus fracture (PHF) patterns, especially between joint preservation and joint replacement techniques. METHODS Between 2012 and 2017, 146 patients (aged 74.1 ± 8.0 years) with complex PHF were treated with locking plates (open reduction-internal fixation [ORIF]) or reverse total shoulder arthroplasty (RTSA). Complications and unplanned revision surgery were recorded in a mid-term follow-up. Potential patient and surgical risk factors for complications were extracted. Univariate and multivariate analyses were conducted. RESULTS Follow-up data were available for 125 patients, 66 (52.8%) of whom were treated with locking plates, and 59 (41.2%) with RTSA. Both groups had comparable Charlson indices. The overall complication rate was 37.8% for ORIF and 22.0% for RTSA, with a revision rate of 12.1% and 5.1%, respectively, as driven primarily by persistent motion deficits. Multivariate analyses demonstrated no significant differences between the 2 procedures (P = .500). However, age was an independent protective factor against overall complications (P = .018). Risk factors for major complications in ORIF included osteoporosis, varus impaction fractures, posteromedial metaphyseal extensions <8 mm, head-shaft displacements >4 mm, and multifragmentary greater tuberosities. For RTSA, higher complication rates were seen in patients with higher Charlson indices, diabetes, or altered (greater) tuberosities. In contrast, Neer's classification system was not predictive in either group. CONCLUSIONS RTSA led to fewer complications than ORIF and thus can be considered a valuable option in complex PHF of the elderly. Paying attention to specific prognostic factors may help to reduce the complication rate.
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Affiliation(s)
- Alexander Klug
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und orthopädische Chirurgie, Frankfurt am Main, Germany.
| | - Dennis Wincheringer
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Jasmin Harth
- Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Kay Schmidt-Horlohé
- Orthopaedicum Wiesbaden-Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Wiesbaden, Germany
| | - Reinhard Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Yves Gramlich
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und orthopädische Chirurgie, Frankfurt am Main, Germany
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