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Bellato E, Fava V, Arpaia A, Calò M, Marmotti A, Castoldi F. Reverse Shoulder Arthroplasty for Proximal Humeral Fractures: Is the Bigliani-Flatow Stem Suitable for Tuberosity Fixation and Healing? J Clin Med 2024; 13:3388. [PMID: 38929917 PMCID: PMC11203955 DOI: 10.3390/jcm13123388] [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: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: The aim of the study was to investigate the clinical, functional, and radiographic results of patients affected by three- or four-part proximal humeral fractures treated with reverse total shoulder arthroplasty, to investigate whether a prosthetic stem nonspecifically designed for fractures (i.e., the Bigliani-Flatow stem) promotes tuberosities' healing, and to evaluate the impact of tuberosity fixation and healing on the outcomes. Methods: Patients' data such as gender, age, side and dominancy, comorbidities, complications during or after surgery, and time lapse between trauma and surgery were prospectively collected. The type of fixation of the stem, the thickness and type of liner, and whether the tuberosities were fixed or not were also recorded. The Constant score weighted on the contralateral limb, QuickDASH, Oxford Shoulder Score, and Subjective Shoulder Value were collected. Tuberosities' healing was assessed with X-rays (anteroposterior, Grashey, and axillary views). Results: Overall, 34 patients were included, with an average follow-up of 42 months. Tuberosities were reinserted in 24 cases and their healing rate was 83%. The mean values were the following: a Constant score of 64, Oxford Shoulder Score of 39, Subjective Shoulder Value of 71, and QuickDASH score of 27. There were no significant differences in the scores or range of motion between patients with tuberosities healed, reabsorbed, or not reattached. There was a better external rotation in the group with healed tuberosities and a longer duration of surgery to reattach tuberosities. Conclusions: The treatment of proximal humerus fractures with the Bigliani-Flatow stem is associated with good clinical and functional results. The healing rate of the tuberosities was high and comparable, if not even better, than the mean rates reported for the stems dedicated to fractures of the proximal humerus and was, therefore, also appropriate for this indication.
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Affiliation(s)
- Enrico Bellato
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Valeria Fava
- Orthopaedic and Trauma Unit, ASST-Sette Laghi, University of Insubria, 21100 Varese, Italy;
| | | | - Michel Calò
- San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | | | - Filippo Castoldi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
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Ameziane Y, Imiolczyk JP, Steinbeck J, Warnhoff M, Moroder P, Scheibel M. [Reverse Shoulder Arthroplasty - Current Concepts]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:211-228. [PMID: 38518806 DOI: 10.1055/a-2105-3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Due to first promising long term outcome data, reverse shoulder arthroplasty experienced an immense increase of usage during the past decade. Moreover, the initial Grammont concept has constantly been refined and adapted to current scientific findings. Therefore, clinical and radiological problems like scapular notching and postoperative instability were constantly addressed but do still remain an area of concern.This article summarises current concepts in reverse shoulder arthroplasty and gives an overview of actual indications like cuff tear arthropathy, severe osteoarthritis, proximal humerus fractures, tumours, fracture sequelae as well as revision surgery and their corresponding clinical and radiological results.
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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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Kahraman S, Karslioglu B, Imren Y, Keskin A, Bilsel K, Dedeoglu SS. Comparison of Functional Outcomes and Complications of Inlay and Onlay Reverse Shoulder Arthroplasty in Neer Type 4 Proximal Humerus Fractures and Cuff Tear Arthropathy: A Multicentric Study. Indian J Orthop 2024; 58:263-270. [PMID: 38425832 PMCID: PMC10899121 DOI: 10.1007/s43465-023-01084-1] [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: 07/09/2023] [Accepted: 12/10/2023] [Indexed: 03/02/2024]
Abstract
Background This multicenter retrospective study was conducted with the objective of comparing the outcomes and complications between inlay and onlay reverse shoulder arthroplasty (RSA) in patients presenting Neer Type 4 proximal humerus fractures and cuff tear arthropathy. The primary aim of this investigation was to assess and juxtapose the clinical as well as functional outcomes of individuals who underwent onlay reverse shoulder arthroplasty with those who underwent inlay reverse shoulder arthroplasty. Methods A retrospective cohort study was conducted, involving patients who had undergone reverse shoulder arthroplasty between the period of 2016 and 2022. The study divided the population into two groups: Group A received inlay humeral components, while Group B received onlay humeral components. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. Range of motion, infection, periprosthetic fractures, and nerve injuries were also assessed. Results The study included 67 patients in Group A and 62 patients in Group B. Group A had significantly better functional outcomes, as indicated by higher ASES and Constant scores (p < 0.05). Group A also had greater shoulder joint motion (p < 0.05). Periprosthetic fractures were significantly more common in Group B (p < 0.05). However, complication rates, including infection and instability, did not significantly differ between the groups (p > 0.05). Nerve injuries occurred in both groups, with slightly higher occurrence in Group B. Conclusion Inlay humeral components in reverse shoulder arthroplasty for Neer Type 4 fractures and cuff tear arthropathy resulted in better functional outcomes, increased range of motion, and lower incidence of periprosthetic fractures compared to onlay components. Onlay components showed potential advantages in reducing instability rates. Further studies with larger samples and standardized protocols are needed to confirm these findings.
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Affiliation(s)
- Sinan Kahraman
- Department of Orthopedics and Traumatology, Demiroglu Bilim University, Buyukdere Cd. No: 120, Sisli, 34394 Istanbul, Turkey
| | - Bulent Karslioglu
- Department of Orthopedics and Traumatology, Prof. Cemil Tascioglu City Hospital, Health Sciences University, Istanbul, Turkey
| | - Yunus Imren
- Department of Orthopedics and Traumatology, Health Sciences University Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Keskin
- Department of Orthopedics and Traumatology, Health Sciences University Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Istanbul, Turkey
| | - Suleyman Semih Dedeoglu
- Department of Orthopedics and Traumatology, Health Sciences University Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Nakazawa K, Manaka T, Minoda Y, Hirakawa Y, Ito Y, Iio R, Nakamura H. Impact of constrained humeral liner on impingement-free range of motion and impingement type in reverse shoulder arthroplasty using a computer simulation. J Shoulder Elbow Surg 2024; 33:181-191. [PMID: 37598837 DOI: 10.1016/j.jse.2023.06.038] [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: 02/03/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Dislocation is a major complication of reverse total shoulder arthroplasty (RSA). The humeral liner may be changed to a constrained type when stability does not improve by increasing glenosphere size or lateralization with implants, and patients, particularly women with obesity, have risks of periprosthetic instability that may be secondary to hinge adduction on the thorax, but there are few reports on its impact on the range of motion (ROM). This study aimed to determine the influence of humeral liner constraint on impingement-free ROM and impingement type using an RSA computer simulation model. METHODS A virtual simulation model was created using 3D measurement software for conducting a simulation study. This study included 25 patients with rotator cuff tears and rotator cuff tear arthropathy. Impingement-free ROM and impingement patterns were measured during flexion, extension, abduction, adduction, external rotation, and internal rotation. Twenty-five cases with a total of 4 patterns of 2 multiplied by 2, making a total of 100 simulations: glenosphere (38 mm normal type vs. lateralized type) and humeral liner constraint (normal type vs. constrained type). There were 4 combinations: normal glenosphere and normal humeral liner, normal glenosphere and constrained humeral liner, lateralized glenosphere and normal humeral liner, and lateralized glenosphere and constrained humeral liner. RESULTS Significant differences were found in all impingement-free ROM in 1-way analysis of variance (abduction: P = .01, adduction: P < .01, flexion: P = .01, extension: P = .02, external rotation: P < .01, and internal rotation: P < .01). Tukey's post hoc tests showed that the impingement-free ROM was reduced during abduction, external rotation, and internal rotation with the combination of the normal glenosphere and constrained humeral liner compared with the other combinations, and improved by glenoid lateralization compared with the combination of the lateralized glenosphere and constrained humeral liner. In the impingement pattern, the Pearson χ2 test showed significantly greater proportion of impingement of the humeral liner into the superior part of the glenoid neck in abduction occurring in the combination of the normal glenosphere and constrained humeral liner group compared with the other groups (P < .01). Bonferroni post hoc tests revealed that the combination of the normal glenosphere and constrained humeral liner was significantly different from that of the lateralized glenosphere and constrained humeral liner (P < .01). Using constrained liners resulted in early impingement on the superior part of the glenoid neck in the normal glenosphere, whereas glenoid lateralization increased impingement-free ROM. CONCLUSION This RSA computer simulation model demonstrated that constrained humeral liners led to decreased impingement-free ROM. However, using the lateralized glenosphere improved abduction ROM.
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Affiliation(s)
- Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Yoichi Ito
- Osaka Shoulder Center, Ito Clinic, Osaka, Japan
| | - Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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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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Fischer J, Welter J, Horn N, Graber S, Pape HC, Jaberg L, Hess F. Is malunion of the greater tuberosity after reverse shoulder arthroplasty in patients with complex proximal humerus fracture associated with worse clinical outcomes? A prospective cohort study. Arch Orthop Trauma Surg 2023; 143:6527-6533. [PMID: 37391524 DOI: 10.1007/s00402-023-04951-6] [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: 07/21/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE To assess patient outcomes following reverse shoulder arthroplasty in patients with complex proximal humerus fracture and the clinical implications of greater tuberosity malunions. METHODS This prospective study included 56 patients who underwent RSA (DELTA XTEND™, DePuy Synthes, Warsaw, IN, USA) to treat proximal humerus fractures. We used a standardized suture technique to reattach the tuberosities. Demographic, comorbidity, and radiological parameters were collected. Assessments at 2-year follow-up (n = 49) are given as follows: range of motion (ROM), pain level, Constant Murley scores (CS), subjective shoulder value (SSV), and tuberosity healing. RESULTS Anatomic tuberosity healing was achieved in 31 (55%) patients (group 1), 14 (25%) had a malunion (group 2), and complete migration occurred in 11 (20%) (group 3). No statistically significant differences between groups 1 and 2 were detected: CS (p = 0.53), SSV (p = 0.07), ROM (forward flexion (FF) p = 0.19, internal rotation (IR) p = 0.34, and external rotation (ER) p = 0.76). Group 3 had poorer outcomes (median [IQR]) than group 1: CS (59 [50-71]) vs. 72 [65-78]), FF (120 [100-150]) vs. 150 [125-160] and ER (- 20 [- 20 to 10] vs. 30 [20-45], respectively. Three complications (group 1) occurred: one-stage revision after low-grade infection, haematoma due to early rivaroxaban intake, and open reduction and internal fixation for acromion insufficiency fracture. No patients showed signs of stem or glenoid loosening after 2 years. CONCLUSION Cases with complete superior migration experienced poorer clinical outcomes than those with anatomic healing. Despite a relatively high malunion rate, the outcomes were not significantly worse in these patients compared to anatomically healed GT cases.
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Affiliation(s)
- Janic Fischer
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - JoEllen Welter
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Nils Horn
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Simon Graber
- Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | | | - Laurenz Jaberg
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
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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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Claro R, Ribau A, Fonte H, Amorim-Barbosa T, Barros LH, Sevivas N. Improved outcomes of older patients with acute and displaced proximal humerus fractures treated with window bone ingrowth fracture-specific stem reverse shoulder arthroplasty. BMC Geriatr 2023; 23:553. [PMID: 37700237 PMCID: PMC10498537 DOI: 10.1186/s12877-023-04210-8] [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: 12/01/2022] [Accepted: 07/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The optimal treatment of displaced proximal humerus fractures (PHFs) in the older people population remains controversial. Reverse shoulder arthroplasty (RSA) is a popular surgical treatment option that provides improved and reproducible results. However, the relevance of fracture-specific stem designs for RSA to improve tuberosity consolidation and shoulder function remains debatable. METHODS This study included all patients 70 years or older with acute and displaced PHFs primarily treated with RSA at a single institution in Portugal, between January 2010 and December 2019 who participated in a minimum follow-up of 2 years. RESULTS A total of 112 patients (15 men and 97 women) with a median clinical follow-up of 52 months were included. The mean age at the time of fracture was 78.6 years. All fractures were classified as Neer types 3 and 4 (n = 50 and n = 62, respectively). A window bone ingrowth fracture-specific stem was used for 86 patients, and a conventional humeral stem was used for 26 patients. Regarding the tuberosity fixation technique, 76 tuberosities were attached using technique A (according to Boileau's principles), 36 tuberosities were attached using technique B (not following Boileau's principles) and 11cases were classified as technique C (if fixation was not possible). The overall survival rate during the 2-year follow-up was 88.2%; however, this decreased to 79% at 5 years. Only three patients had complications (two infections and one dislocation) requiring revision surgery. In the multivariable analysis, the tuberosity fixation technique (P = 0.012) and tuberosity anatomical consolidation (P < 0.001) were associated with improved Constant scores (median Constant Score 62.67 (technique A), 55.32 (technique B), 49.70 (technique C). Fracture-specific humeral implants (P = 0.051), the tuberosity fixation technique (P = 0.041), tuberosity anatomical consolidation (P < 0.001), and dementia influenced the achievement of functional mobility (P = 0.014). Tuberosity anatomic consolidation was positively associated with bone ingrowth fracture-specific humeral implants (P < 0.01) and a strong tuberosity fixation technique (P < 0.01). CONCLUSION RSA is used for complex and displaced fractures of the proximal humerus in older patients. Dementia was negatively correlated with functional outcomes. A window bone ingrowth fracture-specific stem combined with strong tuberosity fixation can yield better clinical and radiological results. LEVEL OF EVIDENCE Level II; prospective comparative study; treatment study.
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Affiliation(s)
- Rui Claro
- Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
- Department of Orthopaedics, Shoulder Unit, Centro Hospitalar Universitário de Santo António, Porto, 4099-001, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar da Universidade Do Porto (ICBAS-UP), Porto, Portugal.
| | - Ana Ribau
- Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Hélder Fonte
- Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Department of Orthopaedics, Hospital das Forças Armadas - Pólo Porto, Porto, Portugal
| | - Tiago Amorim-Barbosa
- Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Luís Henrique Barros
- Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Department of Orthopaedics, Shoulder Unit, Centro Hospitalar Universitário de Santo António, Porto, 4099-001, Portugal
- Instituto de Ciências Biomédicas Abel Salazar da Universidade Do Porto (ICBAS-UP), Porto, Portugal
| | - Nuno Sevivas
- Department of Orthopaedics, Centro Hospitalar Hospitalar Do Médio Ave, Vila Nova de Famalicão, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Grupo Trofa Saúde, Trofa, Portugal
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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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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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13
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Rivera AR, Cardona V. Reverse total shoulder arthroplasty for complex proximal humerus fracture in the elderly: clinical and radiological results. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:131-136. [PMID: 37588446 PMCID: PMC10426567 DOI: 10.1016/j.xrrt.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The use of reverse total shoulder arthroplasty (RSA) for the treatment of proximal humeral fractures (PHFs) is steadily increasing. Better clinical outcomes of RSA have been correlated with tuberosity reattachment and healing. The purpose of this study was to evaluate both the clinical and radiological results of reverse shoulder arthroplasty in the management of a proximal humerus fracture in the elderly. Methods Retrospective study including 400 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 12-month follow-up. In all the cases, the greater tuberosity was reattached with a standardized suture technique and a local bone graft. All the patients were assessed at the 12-month follow-up with Constant-Murley Score (CMS). Radiographic healing of the greater tuberosity was noted. Complications and revision rates were reported. Results Mean final CMS for this cohort was 82 points. The greater tuberosity healed in anatomic position in 85% of the cases (N = 340), obtaining an average CMS of 85 in these patients. Healing of the greater tuberosity did not occur in 13% of the cases (N = 52) and displacement more than 5 mm occurred in 2% (N = 8) of the patients for an average CMS of 60. All patients scored above 120° in forward elevation with a mean of 150°. Mean active external rotation was 35°. The lateralization shoulder angle had a mean of 91° and the distalization shoulder angle had a mean of 54°. Low-grade scapular notching was reported in <1% of the cases. A total of 60 patients presented failure of healing or displacement of the greater tuberosity. Major complications were reported in nine patients. Of these nine patients, two acquired superficial wound infections, while two had deep shoulder prosthetic infection. Two other patients developed hematomas, one sustained an acromial stress fracture, and two had a stem loosening. There were 4 reoperations. Conclusion Reverse shoulder arthroplasty, with the use of a fracture-specific stem, allows an improved rate of greater tuberosity healing and short-term clinical outcomes in the elderly population.
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Affiliation(s)
| | - Victor Cardona
- San Juan Bautista Medical School Caguas, Caguas, Puerto Rico
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14
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Lanzetti RM, Gaj E, Berlinberg EJ, Patel HH, Spoliti M. Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years. Clin Orthop Relat Res 2023; 481:735-747. [PMID: 36383078 PMCID: PMC10013660 DOI: 10.1097/corr.0000000000002480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Proximal humeral fractures are traditionally treated with open reduction and internal fixation (ORIF), but reverse total shoulder arthroplasty (RTSA) has emerged as an increasingly popular treatment option. Although ORIF with angular locking plates is a common treatment for proximal humerus fractures, prior reports suggest high failure and complication rates. Although RTSA has become an increasingly popular option for complex proximal humeral head fractures given its low complication rates, there are concerns it may lead to limited postoperative ROM. Thus, the optimal treatment for patients older than 70 years from a functional and radiographic perspective remains unclear. QUESTIONS/PURPOSES (1) In patients older than 70 years with three-part and four-part proximal humerus fractures, does RTSA result in better functional outcome scores (Constant, American Shoulder and Elbow Surgeons [ASES], and DASH scores) than ORIF with a locking plate? (2) Does RTSA result in greater ROM than ORIF? (3) Does RTSA result in a lower risk of complications than ORIF? (4) In patients with either procedure, what are the rates of negative radiographic outcomes in those treated with ORIF (such as malunion, bone resorption, malalignment, or avascular necrosis) or those with RTSA (such as resorption, notching, and loosening)? (5) At a minimum of 2 years of follow-up, does ORIF result in a greater number of revision procedures than RTSA? METHODS Between January 1, 2013, and June 30, 2018, we treated 235 patients for a proximal humeral fracture. We considered only patients without previous ipsilateral fracture or surgery, other fractures, or radial nerve injuries; age older than 70 years; and patients without neurologic disease or cognitive dysfunction as potentially eligible. Sixty-nine percent (162 patients) of the patients were eligible; a further 31% (73 patients) were excluded because 18% (13 of 73 patients) did not meet the inclusion criteria, 62% (45 patients) underwent nonoperative treatment, and 21% (15 patients) declined to participate. Patients were nonrandomly allocated to receive RTSA if they had supraspinatus Goutallier/Fuchs Grade 3 or 4 atrophy or ORIF if they had supraspinatus Goutallier/Fuchs Grade 1 or 2 atrophy. This left 81 patients who were treated with RTSA and another 81 patients who were treated with ORIF. Among the 81 patients treated with RTSA, 11% (nine patients) were lost to the minimum study follow-up of 2 years or had incomplete datasets, leaving 89% (72 patients) for analysis. Among the 81 patients treated with ORIF, 19% (15 patients) were lost before the minimal study follow-up of 2 years or had incomplete datasets, leaving 82% (66 patients) for analysis. The median follow-up for both groups was 53 months (range 24 to 72 months). The mean age was 76 ± 2.9 years in the RTSA group and 73 ± 2.9 years in the ORIF group. In the RTSA group, 27 patients had a three-part fracture and 45 patients had a four-part fracture. In the ORIF group, 24 patients had three-part fractures and 42 patients had four-part fractures (p = 0.48). Shoulder function was assessed using functional outcome questionnaires (ASES, DASH, and Constant) and active ROM measurements. A surgical complication was defined as any instance of dislocations, fractures, adhesive capsulitis, nerve injuries, or surgical site infections. Radiographic outcomes after ORIF (malunion, tuberosity resorption, or avascular necrosis) and RTSA (notching and osteolysis) were assessed. In calculating the revision rate, we considered unplanned revision procedures only. RESULTS Compared with patients treated with ORIF, patients treated with RTSA had superior improvements in Constant (85.0 ± 7.0 versus 53.0 ± 5.0; mean difference 32 [95% CI 30 to 34]; p < 0.01), ASES (46.3 ± 3.7 versus 30.0 ± 3.5; mean difference 16 [95% CI 15 to 18]; p < 0.01), and DASH scores (40.5 ± 4.2 versus 30.5 ± 2.6; mean difference 10 [95% CI 9 to 11]; p < 0.01). The mean elevation was 135° ± 7° for patients with RTSA and 100° ± 6° for patients with ORIF (mean difference 35 o [95% CI 33 to 37]; p < 0.01). The mean abduction was 131° ± 7° for patients with RTSA and 104° ± 6° for those with ORIF (mean difference 27 o [95% CI 25° to 29°]; p < 0.01). The mean external rotation was 85° ± 5° for patients with RTSA and 64° ± 5° for those with ORIF (mean difference 21° [95% CI 19° to 23°]; p < 0.01). The mean internal rotation was 45° ± 6° for patients with RTSA and 40° ± 6° for those with ORIF (mean difference 5° [95% CI 3° to 7°]; p < 0.01). The risk of complications was not different between patients with ORIF and those with RTSA (5% [three of 66] versus 1% [one of 72]; relative risk 3.3 [95% CI 0.3 to 30.7]; p = 0.30). Among patients with ORIF, 8% had varus malunions (five of 66), 6% had resorption of the greater tuberosity (four of 66), and 2% had avascular necrosis of the humeral head (one of 66). In the RTSA group, 24% (17 of 72 patients) demonstrated reabsorption of periprosthetic bone and 79% of patients (57 of 72) exhibited no notching. The risk of revision was not different between the RTSA and ORIF groups (0% [0 of 72] versus 9% [six of 66]; relative risk 0.07 [95% CI 0.0 to 1.2]; p = 0.07). CONCLUSION In patients older than 70 years with three-part and four-part proximal humerus fractures, primary RTSA resulted in better patient-reported outcome scores and better ROM than ORIF with an angular stable locking plate. Our findings might help surgeons decide between internal fixation and arthroplasty to surgically treat these injuries in older patients. Although RTSA seems to be a preferable treatment modality in view of these findings, longer follow-up is required to evaluate its longevity compared with ORIF with an angular locking plate. Dissimilar to ORIF, which is generally stable once healed, arthroplasties are at a continued risk for loosening and infection even after healing is complete. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Riccardo Maria Lanzetti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, San Camillo-Forlanini Hospital, Rome, Italy
| | - Edoardo Gaj
- San Andrea Hospital, University of Rome “Sapienza,” Rome, Italy
- Ospedale Israelitico di Roma, Rome, Italy
| | - Elyse J. Berlinberg
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Harsh H. Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, San Camillo-Forlanini Hospital, Rome, Italy
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15
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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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16
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Management of Proximal Humeral Fractures in Adults: A Systematic Review and Meta-Analysis. J Orthop Trauma 2023; 37:e80-e88. [PMID: 36155560 DOI: 10.1097/bot.0000000000002494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Differences in function, pain, and reoperation rates were compared between the following treatment options: (1) operative vs. nonoperative treatment and (2) various surgical treatments including open reduction internal fixation, intramedullary nail, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA). DATA SOURCES MEDLINE, Embase, and Cochrane were searched through February 1, 2022. All English-language randomized trials comparing operative and nonoperative treatment of proximal humeral fractures with a control group in patients 18 years or older were included. DATA EXTRACTION Demographic data, functional and pain scores and re-operation rates were extracted. Study quality was determined with the Cochran risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Heterogeneity was determined with the I-squared statistic. DATA SYNTHESIS Meta-analysis of included studies using mean difference and odds ratios where appropriate. CONCLUSIONS Surgical treatment with either locked plates or HA results in similar functional scores and pain outcomes as nonoperative treatment, although plates were associated with higher reoperation rates in 3-part and 4-part fractures. In 3-part and 4-part fractures, RSA results in higher function and pain scores compared with HA. Further high-quality trials should focus on RSA, and further study is required to better define the role of open reduction internal fixation in the younger patient population. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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17
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Viswanathan S, Kashyap AH, Shanker HK. Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures Treated With Trabecular Metal Prosthesis: Medium-Term Results. Cureus 2023; 15:e34652. [PMID: 36895550 PMCID: PMC9991020 DOI: 10.7759/cureus.34652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Reverse shoulder arthroplasty (RSA) is becoming increasingly popular as a primary procedure for complex proximal humeral fractures (PHF) in acute trauma due to more emerging evidence and better patient outcomes. Methods This study is a retrospective case series of 51 patients who underwent a trabecular metal RSA for non-reconstructable, acute three or four-part PHF performed by a single surgeon between 2013 and 2019 with a minimum follow-up of three years. This included 44 females and seven males. Mean age was 76 years (range: 61-91 years). Oxford shoulder score (OSS) along with relevant patient information relating to demographics and functional outcomes were collected at regular intervals in outpatient clinic follow-ups. Complications were addressed accordingly during treatment and follow-up. Results The mean follow-up duration was 5.08 years. Two patients were lost to follow-up and nine patients died due to other causes. Four of them had developed severe dementia and were excluded as an outcome score from them could not be acquired. Two patients who had surgery beyond four weeks post-injury were excluded. Thirty-four patients in total were followed up. Patients had good range of motion and mean OSS of 40.28 post-operatively. The overall complication rate was 11.7%, and none of the patients had deep infections, scapular notching, or acromial fractures. Revision rate was 5.8% at mean follow-up of five years and one month (range: three years to nine years two months). Greater tuberosity union following intra-operative repair was evident on radiographs in 61.7% of the patients. Conclusion RSA is certainly a rewarding surgery in patients with complex PHF and was associated with good post-operative OSS along with patient satisfaction, and positive radiological outcomes at minimum three-year follow-up.
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Affiliation(s)
| | - Anjali Hema Kashyap
- Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Health Campus, Aberdeen, GBR
| | - Harish Kashyap Shanker
- Trauma and Orthopedics, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Paisley, GBR
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18
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Cassart Masnou E, Ruiz Macarrilla L, Mora Solé E, García Perdomo D, Pérez Andrés R. Is the Position and Union of the Tuberosities Assessable by Means of the Simple Radiograph After Reverse Shoulder Arthroplasty for Complex Proximal Humerus Fractures? J Shoulder Elb Arthroplast 2023; 7:24715492231152149. [PMID: 36727142 PMCID: PMC9884950 DOI: 10.1177/24715492231152149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
Background The assessment of tuberosity position and union in reverse shoulder arthroplasty (RSA) for complex proximal humerus fractures (PHF) has been carried out by means of routine simple radiographs. To evaluate the interobserver agreement and intraobserver reproducibility of the simple radiograph in comparison to the CT scan. Methods The position and consolidation of the tuberosities in 2 radiographic projections and in a CT scan of 32 consecutive patients operated on a RSA for PHF was assessed by 5 observers. Interobserver agreement and intraobserver reproducibility in both imaging tests were also assessed. Results The interobserver agreement for the greater tuberosity position was 0.52 in the simple radiograph and 0.45 in the CT scan. For the greater tuberosity union, agreement was moderate in the simple radiograph (0.52), but fair in the CT scan (0.35). For the lesser tuberosity position and union, the agreement was fair in the radiograph and poor in the CT scan. Conclusion Only moderate agreement was observed in the assessment of the position and union of the tuberosities in the RSA for PHF in the simple radiograph and no improvement in it was seen for the 2D CT scan.
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Affiliation(s)
- Elisa Cassart Masnou
- Hospital Universitari Germans Trias i Pujol,
Barcelona, Spain,Elisa Cassart Masnou, Crta Canyet s/n
Orthopaedic Surgery Department, Hospital Germans Trias i Pujol, 08916 Badalona,
Barcelona, Spain.
| | | | - E Mora Solé
- Hospital Universitari Germans Trias i Pujol,
Barcelona, Spain
| | | | - R Pérez Andrés
- Hospital Universitari Germans Trias i Pujol,
Barcelona, Spain
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19
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Schuette HB, Starcher NJ, Goubeaux CC, DeGenova DT, Triplet JJ, Mehta S, Taylor BC. Reverse shoulder arthroplasty for proximal humerus fractures: a comparison of the deltoid split and deltopectoral approaches. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04746-1. [PMID: 36596991 DOI: 10.1007/s00402-022-04746-1] [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: 06/20/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) is a common treatment for three- and four-part proximal humerus fractures. RSA is commonly performed through a deltopectoral (DP) surgical approach; however, a deltoid split (DS) approach has been described. The purpose of this study was to compare the intraoperative and postoperative outcomes of patients undergoing RSA for proximal humerus fractures through a DP and DS approach. MATERIALS AND METHODS A retrospective study of patients who underwent RSA for proximal humerus fractures at our level 1 trauma center was performed. Patients were evaluated at a minimum 1-year follow-up. Intraoperative outcomes as well as patient-reported outcome measures (PROMs) were analyzed. Postoperative complications, reoperation rates, and radiographic outcomes were evaluated. RESULTS Sixteen patients were included in the DP group and 13 patients in the DS group. The average follow-up was 28.6 months in the DP group and 21.1 months in the DS group. There were no significant differences in patient demographics or injury characteristics. Operative time was significantly shorter in the DS group (103 min) compared to the DP group (123 min). Tuberosity repair was performed in 81.3% of patients in the DP group and 92.3% of patients in the DS group. No significant differences were found in PROMs at final follow-up. There were no significant differences in postoperative complications. Three patients in the DP group and one patient in the DS group required reoperation. Lastly, 81.8% of patients achieved tuberosity union in the DS group and 66.7% in the DP group; however, this did not reach statistical significance. CONCLUSION This study demonstrates that RSA for proximal humerus fractures performed through a DS or DP approach may result in similar intraoperative and postoperative outcomes, with no difference in reoperation or complication rates.
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Affiliation(s)
- Hayden B Schuette
- Department of Orthopedic Surgery, OhioHealth/Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA.
| | - Nathaniel J Starcher
- Department of Orthopedic Trauma, OhioHealth/Grant Medical Center, Columbus, OH, USA
| | - Craig C Goubeaux
- Department of Orthopedic Surgery, OhioHealth/Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA
| | - Daniel T DeGenova
- Department of Orthopedic Surgery, OhioHealth/Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA
| | - Jacob J Triplet
- Department of Orthopedic Surgery, Indiana University Health, Muncie, IN, USA
| | - Sanjay Mehta
- Department of Orthopedic Trauma, OhioHealth/Grant Medical Center, Columbus, OH, USA
| | - Benjamin C Taylor
- Department of Orthopedic Trauma, OhioHealth/Grant Medical Center, Columbus, OH, USA
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20
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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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21
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The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population. J Clin Med 2022; 11:jcm11195832. [PMID: 36233699 PMCID: PMC9570675 DOI: 10.3390/jcm11195832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Proximal humerus fracture (PHF) is a common injury in the older population. While the majority of these fractures are treated non-operatively, a small subset of patients may benefit from surgical treatment. However, there continues to be an ongoing debate regarding the indications and ideal surgical treatment strategy. The use of reverse total shoulder arthroplasty (RTSA) has resulted in a paradigm shift in the treatment of PHFs in the older population. Unique biomechanical principles and design features of RTSA make it a suitable treatment option for PHFs in the older population. RTSA has distinct advantages over hemiarthroplasty and internal fixation and provides good pain relief and a reliable and reproducible improvement in functional outcomes. As a result, there has been an exponential increase in the volume of RTSA in the older population in last decade. The aim of this paper is to review the current concepts, outcomes and controversies regarding the use of RTSA for the treatment of PHFs in the older population.
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22
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Kimmeyer M, Rentschler V, Schmalzl J, Gerhardt C, Lehmann LJ. [Fracture analysis, indication for endoprosthesis and implant selection in proximal humeral fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:671-680. [PMID: 35833976 DOI: 10.1007/s00113-022-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Proximal humeral fractures (PHF) are the third most common fracture in humans and the incidence is increasing. There are basically three treatment strategies: conservative, joint-preserving reconstructive or joint-replacing procedures. In addition to fracture morphology, patient-specific and surgeon-specific factors are particularly important when deciding on treatment. The experience and training of the surgeon also play a decisive role. In the case of joint-preserving treatment, the risk of osteosynthesis failure and of sequelae of the fracture must always be assessed. If conservative or reconstructive treatment methods are not promising, the joint-replacing procedure is the treatment of choice. The anatomical fracture prosthesis is only indicated, if at all, for young patients with a destroyed humeral head with a preserved rotator cuff and large fragments of the tuberosities. In advanced age, the implantation of a reverse endoprosthesis is increasingly used for dislocated, multifragmentary PHF. In both procedures, the anatomical healing of the tuberosities has a significant impact on the functional outcome.
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Affiliation(s)
- M Kimmeyer
- Klinik für Unfall‑, Handchirurgie und Sportmedizin, ViDia Kliniken Karlsruhe, Steinhäuserstraße 18, 76135, Karlsruhe, Deutschland.
| | - V Rentschler
- Klinik für Unfall‑, Handchirurgie und Sportmedizin, ViDia Kliniken Karlsruhe, Steinhäuserstraße 18, 76135, Karlsruhe, Deutschland
| | - J Schmalzl
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - C Gerhardt
- Klinik für Unfall‑, Handchirurgie und Sportmedizin, ViDia Kliniken Karlsruhe, Steinhäuserstraße 18, 76135, Karlsruhe, Deutschland
| | - L J Lehmann
- Klinik für Unfall‑, Handchirurgie und Sportmedizin, ViDia Kliniken Karlsruhe, Steinhäuserstraße 18, 76135, Karlsruhe, Deutschland
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23
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Walch A, Edwards TB, Kilian CM, Boileau P, Walch G, Athwal GS. Hemi-reverse revision arthroplasty in the setting of severe glenoid bone loss. J Shoulder Elbow Surg 2022; 31:1859-1873. [PMID: 35339707 DOI: 10.1016/j.jse.2022.02.018] [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: 11/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid bone loss is one of the main challenges in revision of failed shoulder arthroplasties. The concept of a hemi-reverse procedure is to implant a glenoid baseplate and glenosphere to protect the glenoid reconstruction to allow it to heal and to preserve the joint space for a potential second-stage humeral component implantation. The purpose of this study was to report the results of hemi-reverse procedures. METHODS Revision to a hemi-reverse procedure was performed in 15 patients: 8 with a failed anatomic total shoulder arthroplasty, 3 with a failed reverse shoulder arthroplasty, 3 with a failed humeral hemiarthroplasty, and 1 with placement of a cement spacer owing to sepsis after a total shoulder arthroplasty. After complete removal of the initial prosthesis, all patients underwent glenoid reconstruction with bone grafting and implantation of a reverse arthroplasty baseplate and glenosphere. A humeral implant was not placed in any case. The patients were prospectively followed up and underwent complete clinical and radiologic studies preoperatively and postoperatively at a minimum of 2 years after the surgical procedure. RESULTS Thirteen hemi-reverse implants and glenoid bone grafts healed (86%) and remained radiographically stable. One hemi-reverse construct migrated and became mechanically loose, which was attributed to absent fixation of the central post in the native glenoid bone. In 1 patient, an implant-related infection developed; irrigation and debridement were performed, in addition to revision to a resection arthroplasty. After documented radiographic healing of the hemi-reverse glenoid reconstruction, 5 patients underwent a second-stage revision to a reverse procedure with insertion of a humeral component at a median of 6 months (interquartile range [IQR], 6-8 months). In this group, the median follow-up period was 73 months (IQR, 45-153 months), the median Constant score was 48 (IQR, 41-56), median active forward elevation was 135° (IQR, 100°-150°), and the median Subjective Shoulder Value was 50% (IQR, 50%-60%). In the group of 9 patients with remaining hemi-reverse implants, the median follow-up period was 38 months (IQR, 29-60 months), the median Constant score was 41 (IQR, 38-46), median active forward elevation was 100° (IQR, 80°-100°), and the median Subjective Shoulder Value was 50% (IQR, 40%-60%). CONCLUSION The hemi-reverse procedure is an effective revision procedure to reconstruct a severely deficient glenoid. The hemi-reverse procedure may function as the definitive procedure, with satisfactory outcomes. Additionally, in patients who undergo the hemi-reverse procedure, second-stage revision to a total reverse procedure can be performed once imaging confirms bone graft and construct stability.
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Affiliation(s)
- Arnaud Walch
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France.
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | | | | | | | - George S Athwal
- Roth|McFarland Hand and Upper Limb Center, Western University, St Joseph's Health Care London, London, ON, Canada
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24
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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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25
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Han PF, Yang S, Wang YP, Hou XD, Li Y, Li XY. Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update. Exp Ther Med 2022; 24:637. [PMID: 36160890 PMCID: PMC9468857 DOI: 10.3892/etm.2022.11574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022] Open
Abstract
The present meta-analysis was conducted to compare the safety and effectiveness of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in the treatment of osteoporotic proximal humeral fractures in elderly patients. The Embase, Pubmed Central, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical databases were searched between January 2009 and January 2022 to identify relevant studies. According to the search strategy, a total of 210 associated studies were retrieved and 16 were finally included. Review Manager 5.4 software was used for the data analysis. This study indicated that patients in the RSA group had significantly improved treatment outcomes compared with patients in the HA group, as assessed by Constant-Murley Shoulder Outcome Score (95% CI, 1.69-3.76; P<0.001), American Shoulder and Elbow Surgeons score (95% CI, 11.81-24.88; P<0.001) and shoulder range of motion (ROM; 95% CI, 3.41-9.07; P<0.001). However, the HA group was superior to the RSA group in terms of the Oxford Shoulder score (95% CI, 2.89-11.11; P<0.001). There was no significant statistical difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand score and complications. Overall, for the treatment of osteoporotic proximal humeral fractures in the elderly, the RSA group had improved postoperative ROM and functional scores compared with the HA group, without significant difference in the incidence of complications. However, HA remains a safe and reliable treatment option.
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Affiliation(s)
- Peng-Fei Han
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yue-Peng Wang
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Xue-Dong Hou
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yuan Li
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Xi-Yong Li
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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26
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Vall M, Natera L, Witney-Lagen C, Imam MA, Narvani AA, Sforza G, Levy O, Relwani J, Consigliere P. Reverse shoulder replacement versus hemiarthroplasty for proximal humeral fracture in elderly patients: a systematic review. Musculoskelet Surg 2022; 106:357-367. [PMID: 35974216 DOI: 10.1007/s12306-022-00761-y] [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: 08/17/2021] [Accepted: 07/28/2022] [Indexed: 12/01/2022]
Abstract
This systematic review of the literature aims to analyse current knowledge to inform choice between hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA) for managing proximal humerus fractures (PHF) in elderly patients; the aim is to understand if rTSA can be considered the gold standard for treating PHF in the elderly when surgical fixation or conservative treatment is not viable options. Studies reporting outcomes and complications of PHF treated with shoulder arthroplasty in the elderly were included. Studies were in English and published after 2008. Evidence levels I, II, III and IV were included. According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PubMed search engines, as well as the Cochrane Central Register of Controlled Trials. General data collected were study design, number of patients treated with HA and rTSA, age of patients (mean, mean and SD, mean and range), length of follow-up, type of implant, and clinical outcomes. rTSA can be regarded as the gold standard for surgical management of displaced 3 and 4-part fractures in the elderly. However, the literature offers mostly low-quality studies, thereby requiring further work to achieve a full understanding of this important topic.
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Affiliation(s)
- M Vall
- Hospital General de Granollers, Barcelona, Spain.,Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - L Natera
- Hospital General de Granollers, Barcelona, Spain.,The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - C Witney-Lagen
- Hospital General de Granollers, Barcelona, Spain.,University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - M A Imam
- Hospital General de Granollers, Barcelona, Spain.,Ashford and St Peters NHS FT, Chertsey, UK.,Fortius Clinic, London, UK.,Smart Health Unit, University of East London, London, UK
| | - A A Narvani
- Hospital General de Granollers, Barcelona, Spain.,Ashford and St Peters NHS FT, Chertsey, UK.,Fortius Clinic, London, UK
| | - G Sforza
- Hospital General de Granollers, Barcelona, Spain.,The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - O Levy
- Hospital General de Granollers, Barcelona, Spain.,The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK.,Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - J Relwani
- Hospital General de Granollers, Barcelona, Spain.,East Kent Hospitals University NHS Foundation Trust, Ashford, Margate and Canterbury, UK
| | - P Consigliere
- Hospital General de Granollers, Barcelona, Spain. .,The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK. .,East Kent Hospitals University NHS Foundation Trust, Ashford, Margate and Canterbury, UK.
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27
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Imiolczyk JP, Brunner U, Imiolczyk T, Freislederer F, Endell D, Scheibel M. Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11102835. [PMID: 35628961 PMCID: PMC9145800 DOI: 10.3390/jcm11102835] [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: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
Head-split fractures are proximal humerus fractures (PHF) that result from fracture lines traversing the articular surface. While head-split fractures are rare, surgical treatment of these complex injuries can be extremely challenging and is associated with high rates of complications. Treatment using primary reverse shoulder arthroplasty (RSA) has been associated with moderate complication rates and reproducible clinical results. The aim of this study was to evaluate clinical and radiographic outcomes, and complication rates of RSA for head-split PHF. Twenty-six patients were evaluated based on Constant Score (CS) and range of motion of both shoulders and Subjective Shoulder Value (SSV). Radiographic analysis evaluated tuberosity healing, prosthetic loosening and scapular notching. Patients achieved good clinical results with a CS of 73.7 points and SSV of 82% after a mean follow-up of 50 months. The relative CS comparing operated versus the unaffected shoulder was 92%. Greater tuberosity healing was achieved in 61%. Patients who suffered a high-energy trauma reached a significantly greater functional outcome. Patients who suffered multifragmentation to the humeral head performed the worst. There were no cases of loosening; scapular notching was visible in two cases. The complication rate was 8%. RSA is an adequate treatment option with for head-split PHF in elderly patients.
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Affiliation(s)
- Jan-Philipp Imiolczyk
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, 13353 Berlin, Germany
- Correspondence: (J.-P.I.); (M.S.)
| | - Ulrich Brunner
- Department of Trauma and Orthopedic Surgery, Krankenhaus Agatharied, 83734 Hausham, Germany;
| | - Tankred Imiolczyk
- Department of Mathematics, University of Mannheim, 68131 Mannheim, Germany;
| | - Florian Freislederer
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland; (F.F.); (D.E.)
| | - David Endell
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland; (F.F.); (D.E.)
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, 13353 Berlin, Germany
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland; (F.F.); (D.E.)
- Correspondence: (J.-P.I.); (M.S.)
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28
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Lin CC, Karlin E, Boin MA, Dankert JF, Larose G, Zuckerman JD, Virk MS. Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202205000-00006. [PMID: 35536998 DOI: 10.2106/jbjs.rvw.21.00245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
» The majority of proximal humeral fractures (PHFs) in patients who are ≥65 years of age are treated nonoperatively, but certain complex fracture patterns benefit from surgical intervention. However, there continues to be debate regarding the indications for surgery and the optimal surgical treatment (repair versus replacement) in this population. » Reverse total shoulder arthroplasty (RTSA) has grown in popularity for surgical treatment of fracture-dislocations and displaced complex PHFs in patients who are ≥65 years of age; it has definite advantages over surgical repair and hemiarthroplasty, but this finding requires additional higher-quality evidence. » RTSA provides early pain relief and return of shoulder function as well as predictable elevation above shoulder level in the forward plane, but the indications for and understanding of the effect of timing on RTSA after a PHF continue to evolve. » RTSA for an acute PHF is indicated in patients who are ≥65 years of age with 3- and 4-part fracture-dislocations, head-split fractures, and severely displaced fractures, and is an option in patients who are not able to tolerate nonoperative treatment of severely displaced 3- and 4-part fractures. » RTSA is also indicated as a salvage operation for PHFs that have failed initial surgical repair (i.e., fixation failure, implant failure, rotator cuff failure, or osteonecrosis) and is an option for symptomatic nonunion or malunion after nonoperative treatment.
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Affiliation(s)
| | - Elan Karlin
- Georgetown University School of Medicine, Washington, DC
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29
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Simultaneous Bilateral Proximal Humerus Fractures Treated with Single-Stage Bilateral Reverse Shoulder Arthroplasty. Case Rep Orthop 2022; 2022:2162331. [PMID: 35496949 PMCID: PMC9045964 DOI: 10.1155/2022/2162331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 03/20/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Simultaneous bilateral fractures of the proximal humerus are infrequent, and simultaneous bilateral three- or four-part fractures are even rarer. Reverse shoulder arthroplasty (RSA) is being used increasingly for the treatment of three- and four-part fractures of the proximal humerus. However, treatment of simultaneous bilateral fractures of the proximal humerus is difficult because of concern about postoperative immobilization and rehabilitation. Case Presentation. A 75-year-old woman presented with bilateral shoulder pain subsequent to a fall on the street. Physical examination and radiographs showed simultaneous bilateral fractures of the proximal humerus. The right side fracture was classified as a four-part fracture and the left side fracture as a three-part fracture, according to Neer's classification. The right shoulder had a risk of avascular necrosis of the humeral head. For the left shoulder, the fracture type had caused ischemia of the humeral head. Single-stage bilateral RSA was performed 9 days after the injury. An abduction pillow was applied for 5 weeks postoperatively. Passive motion exercises were permitted starting at 4 weeks postoperatively, and active range of motion exercises were permitted at 6 weeks postoperatively. At the patient's most recent follow-up 30 months after surgery, the patient reported no restriction of the activities of daily living. Radiographs revealed no lucent line on the humerus and glenoid components, although bone resorption and superior retraction of the tuberosities on both sides were observed. Conclusions Single-stage bilateral RSA improved shoulder function, but healing of the greater tuberosity can affect the improvement in external rotation after the operation. Although a long-term follow-up is needed, single-stage bilateral RSA appears to be a viable treatment option.
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30
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Current Role of Reverse Total Shoulder Arthroplasty for Fractures of the Proximal Humerus. J Orthop Trauma 2022; 36:e98-e105. [PMID: 34294668 DOI: 10.1097/bot.0000000000002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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31
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Rossi LA, Tanoira I, Ranalletta M, Kunze KN, Farivar D, Perry A, Chahla J. Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e101-e119. [PMID: 34737086 DOI: 10.1016/j.jse.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this systematic review was to compare functional outcomes, complications, and revision rates between cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs). METHODS A systematic search was performed in April 2021 within PubMed, Scopus Web of Science, and Cochrane Library databases for clinical studies reporting outcomes of RSA performed for PHF. Included studies were published in English, had a minimum 1-year follow-up, specified whether the humeral stem was cemented (cRSA) or uncemented (ucRSA), and were evidence level I-IV. Data including range of motion (ROM), functional status, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant-Murley score, visual analog scale (VAS) score, tuberosity healing, complications, and reoperations were extracted. DerSimonian-Laird random effects models with subgroup stratification analyses were applied to investigate differences in outcomes between patients with cRSA and ucRSA. RESULTS A total of 45 studies comprising 1623 patients were included. The overall pooled age was 75.9 ± 3.4 years. At a mean follow-up of 34.6 (range, 12-108) months, there were no significant differences in ROM, VAS score, Constant-Murley score, rate of tuberosity healing, or reoperation rates between the cRSA and ucRSA cohorts. The mean postoperative ASES score in the cRSA cohort (73.9, 95% CI 71.4-76.5) was significantly lower than the ucRSA cohort (82.9, 95% CI 75.9-90.0, P = .013). The incidence of postoperative all-cause complications was significantly lower in the cRSA cohort (5.5%, 95% CI 4.0%-6.9%) compared with the ucRSA cohort (9.7%, 95% CI 4.5%-14.9%, P = .044). CONCLUSION The use of uncemented humeral stems in RSA for PHF confers similar functional results to the use of cemented stems in terms of pain, range of motion, functional scores, and tuberosity healing. Although the rate of complications was significantly higher in the uncemented cohort compared with the cemented cohort (9.7% vs. 5.5%, respectively), the rate of reoperations was similar between the groups (1.6% vs. 1.9%, respectively). The uncemented reverse prosthesis seems to be a valid alternative for the management of patients with complex proximal humerus fractures.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Allison Perry
- University of Cincinnati College of Medicine, Chicago, IL, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, IL, USA
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Panagopoulos GN, Pugliese M, Leonidou A, Butt F, Jaibaji M, Megaloikonomos PD, Consigliere P, Sforza G, Atoun E, Levy O. Acute versus delayed reverse total shoulder arthroplasty for proximal humeral fractures: a consecutive cohort study. J Shoulder Elbow Surg 2022; 31:276-285. [PMID: 34400290 DOI: 10.1016/j.jse.2021.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of displaced proximal humeral fractures (PHFs) remains controversial. Open reduction-internal fixation (ORIF) can be challenging, especially in elderly patients with poor bone quality, whereas hemiarthroplasty has had unpredictable outcomes. Conservative treatment may result in severe fracture sequelae with poor outcomes, requiring late reverse total shoulder arthroplasty (RTSA) in many cases. The past few years have seen a shift toward the use of RTSA for the treatment of PHFs. The aim of this study was to compare the outcomes of RTSA between patients with acute fractures and patients who underwent delayed RTSA for fracture sequelae. Our hypothesis was that the outcomes of RTSA for acute PHFs would be better than those of delayed RTSA for fracture sequelae. METHODS We followed up 36 patients with a mean age of 79.1 years who underwent primary RTSA for acute PHFs and 56 patients with a mean age of 72.1 years who underwent RTSA in delayed fashion for fracture sequelae, including failed ORIF. The minimum follow-up period was 24 months. The mean follow-up period was 39.3 months in the acute RTSA group and 56.6 months in the delayed RTSA group. Demographic data, radiographs, and surgery data were prospectively collected and analyzed. At final follow-up, range of motion and radiographic analysis findings, as well as the Subjective Shoulder Value (SSV) and Constant score (CS), were recorded. RESULTS The clinical results favored the group undergoing acute RTSA for acute PHFs, with a mean SSV of 8.3 of 10 and adjusted CS of 88.9% compared with a mean SSV of 8.0 of 10 and adjusted CS of 77.6% in the group undergoing late RTSA for fracture sequelae-but without statistically significant differences between the groups. Although the acute RTSA group showed slightly better range-of-motion values, no statistically significant differences were found between the groups. No intraoperative complications occurred. The time from injury to the regaining of good pain-free function was significantly shorter in the acute RTSA group. CONCLUSION Although there were no statistically significant differences in outcomes between early RTSA for acute PHFs and late RTSA for fracture sequelae, the time from injury to the regaining of good pain-free function was significantly shorter in the acute RTSA group. Therefore, we advocate early RTSA for acute PHFs in elderly patients to provide a quicker recovery and an early return to good predictable outcomes with a much shorter period of pain and discomfort. In cases of failed conservative treatment, malunion, or failed ORIF, salvage RTSA has the potential to provide a good outcome.
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Affiliation(s)
| | - Mattia Pugliese
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Faisal Butt
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Monketh Jaibaji
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | | | | | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Cemented versus uncemented reverse shoulder arthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg 2022; 31:261-268. [PMID: 34358669 DOI: 10.1016/j.jse.2021.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of this study were (1) to compare postoperative range of motion (ROM) and functional outcomes in patients with proximal humeral fractures operated on with cemented or uncemented reverse shoulder arthroplasty (RSA), (2) to compare the rate of tuberosity healing between cemented and uncemented stems, (3) to determine whether there are significant differences in functional outcomes between patients with healed tuberosities and those with unhealed tuberosities, and (4) to compare complications and revision rates in patients with cemented RSA and uncemented RSA. METHODS A cemented RSA was performed early in the study period, which represented a historical cohort (January 2015 to January 2017), followed by a transition to the uncemented RSA later in the study period (February 2017 to February 2019). We excluded 22 cases from postoperative evaluation because of fracture sequelae, age < 65 years, death, and institutionalization; 3 patients were lost to follow-up. The remaining 67 cases (32 cemented and 35 uncemented) underwent clinical and radiographic evaluation by 2 independent fellowship-trained shoulder surgeons. Patients were assessed regarding ROM and the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and Single Assessment Numeric Evaluation score. All intraoperative and postoperative complications were recorded. RESULTS The mean follow-up period was 41 months (range, 24-72 months), and the mean age was 74 years (range, 65-84 years). Mean postoperative active elevation, internal rotation, external rotation in abduction, and external rotation in adduction were 130° (±15°), 27° (±5°), 28° (±10°), and 16° (±6°), respectively. The mean postoperative visual analog scale, American Shoulder and Elbow Surgeons, Constant, and Single Assessment Numeric Evaluation scores were 1.8 (±0.8), 74 (±6), 58 (±11), and 74% (±8), respectively. There were no significant differences in final ROM and functional scores between the cemented and uncemented groups. The rate of tuberosity healing did not vary significantly in relation to whether the stem was cemented. The subgroup of patients with tuberosity healing presented significantly better active elevation, external rotation, and Constant scores than the subgroup without tuberosity healing. There were 5 complications (7%) and no cases of aseptic humeral stem loosening. CONCLUSION In the short term (mean, 41 months), there were no significant differences in postoperative ROM, functional outcomes, complications, and revisions between patients operated on with cemented RSA and those operated on with uncemented RSA for proximal humeral fractures. Patients with healed tuberosities presented significantly better ROM and functional scores than patients without tuberosity healing. The cementation of the stem did not significantly affect the rate of tuberosity healing.
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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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Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem? INTERNATIONAL ORTHOPAEDICS 2022; 46:635-644. [PMID: 35034145 DOI: 10.1007/s00264-021-05284-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purposes of this study were to compare functional outcomes, radiographic stem changes and complication rate in patients with proximal humeral fractures operated with cemented or uncemented RSA. METHODS Retrospective review of 68 primary RSAs in PHF, 45 cemented/23 uncemented. Functional outcomes were evaluated according to constant, ASES scales and the range of motion (ROM). Radiographic assessment was performed at a minimum of two years post-operatively. RESULTS The mean follow-up cemented/uncemented was 37.8/26.5 months (p = .04) and the mean age 78/80 years old (p = .09). The functional outcome and range of movement were equivalent in the two groups except for the forward flexion that was significantly higher in the cemented group (p = .03). Stress shielding was seen in 30.4% of uncemented group and none in the cemented. Anatomic tuberosity healing was significantly higher with uncemented components compared with cemented components (64% vs 91%, p = .02). Cemented stems had radiolucent lines with a width of 2 mm or more in three or more Gruen zones in 9% vs 0% in the uncemented group and an evident change in the stem position was present in 4% vs 0% in the non-cemented group. CONCLUSION At mid-term follow-up, no differences in functional outcomes were detected depending on the stem fixation technique. Cemented stems, however, have a complication rate (including stem loosening) significantly higher than press-fit stems.
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Clinical outcomes of reverse total shoulder arthroplasty for elective indications versus acute 3- and 4-part proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e14-e21. [PMID: 34454040 DOI: 10.1016/j.jse.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has continued to increase in clinical utility and popularity as an effective treatment for cuff tear arthropathy (CTA), irreparable rotator cuff tears (RCTs), osteoarthritis, and acute 3- and 4-part proximal humeral fractures. Performing RTSA for acute proximal humeral fractures presents the unique challenges of tuberosity management, bone loss, and instability compared with elective indications such as CTA or irreparable RCTs. The purpose of this study was to compare the clinical outcomes, active range of motion (ROM), radiographic outcomes, and complications between patients undergoing elective RTSA (RTSA-E) and those undergoing RTSA for fracture (RTSA-F). METHODS A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We queried 3 electronic databases (Embase, Cochrane, and PubMed) using the search term "reverse" AND "shoulder" AND "arthroplasty." Studies investigating the clinical outcomes of RTSA for traumatic and/or elective indications were included. Studies were excluded if they included RTSA performed for fracture sequelae, inflammatory arthritis, post-traumatic osteoarthritis, or avascular necrosis. Data collected included patient demographic characteristics, subjective outcome measurements, ROM, and complications. The pooled means and proportions along with their 95% confidence intervals were generated by a random-effects model that incorporated the between-study variations in weighting. RESULTS A total of 134 studies (11,651 shoulders) investigating the clinical outcomes of RTSA-E patients and 66 studies (3117 shoulders) investigating RTSA-F patients were included in this systematic review. Analysis of patient-reported outcomes demonstrated that RTSA-F patients experienced significantly lower Constant scores than RTSA-E patients; however, relative Constant scores, Simple Shoulder Test scores, Disabilities of the Arm, Shoulder and Hand scores, American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores were similar. RTSA-F patients also had significantly lower forward elevation, abduction, and external rotation. RTSA-F patients experienced tuberosity complications at a significantly higher rate than RTSA-E patients (25.9% vs. 4.1%). There was no significant difference between the 2 groups in terms of other complications such as heterotopic ossification, radiographic loosening, revision, nerve injury, postoperative stiffness, infection, dislocation, and component loosening. DISCUSSION RTSA performed for acute 3- and 4-part proximal humeral fractures yields overall worse clinical outcomes and active ROM compared with RTSA performed for elective indications including CTA, massive irreparable RCTs, and osteoarthritis with deformity. Tuberosity healing may be a major contributing factor to the difference in clinical outcomes. In the setting of RTSA-F, patient and surgeon expectations may need to be tempered and appropriate measures undertaken to optimize tuberosity healing.
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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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Abstract
Background Fracture reverse shoulder arthroplasty (fRSA) in geriatric, complex dislocated proximal humerus fractures is becoming the standard treatment next to conservative treatment. fRSA is a multifaceted, reasonably challenging procedure of which functional outcomes and complication rates are likely to depend on the experience of the surgeon. The goal of this study was to determine whether there is a learning curve for fRSA. Methods All patients with a dislocated multipart proximal humerus fracture that were treated with an fRSA between 2013 and 2019 in a specialized institution were included. The functional outcomes (Constant Shoulder Score, Oxford Shoulder Score, and range of motion), complications, and operation time of fRSA were assessed with linear regression plots and cumulative summation analysis to establish whether a learning curve was present. Results In this cohort study, 50 patients were included. They had a mean age of 77.1 years and were treated with an fRSA by one trauma surgeon. Learning curves were distinguished for functional outcomes, complications, and operation time based on learning targets for daily activity and the mean complications and operation time. Results indicated that an optimal treatment is achieved after performing 20 fRSAs. Conclusion The results show that functional outcomes of PHFs treated with an fRSA improve with surgical experience. Also, outcomes are getting less variable after about 20 procedures. Surgeons starting this procedure should be aware of the learning curve and, therefore, should consider guidance from an experienced surgeon to swiftly optimize functional outcomes and prevent unnecessary complications.
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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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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:jcm10184146. [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
- Correspondence: ; Tel.: +41-44386-1111
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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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Laas N, Engelsma Y, Hagemans FJA, Hoelen MA, van Deurzen DFP, Burger BJ. Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial. J Orthop Trauma 2021; 35:252-258. [PMID: 33470595 DOI: 10.1097/bot.0000000000001978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare outcomes between hemiarthroplasty (HA) and reversed shoulder arthroplasty (RSA) as a treatment for dislocated 3-part and 4-part proximal humerus fractures in the elderly population. DESIGN Prospective multicenter randomized controlled trial. SETTING Three Level-1 trauma centers. PATIENTS/PARTICIPANTS This study included 31 patients of which 14 were randomized into the HA group and 17 into the RSA group. INTERVENTION Patients randomized to the HA group were treated with a cemented-stem Aequalis-fracture HA and patients randomized to the RSA group with a cemented-stem Aequalis-fracture RSA. MAIN OUTCOME MEASUREMENTS Primary outcomes consisted of range of motion and constant score. Secondary outcomes were the visual analog scale for pain, DASH score, SF-12 scores, and radiographic outcomes. RESULTS After 6 and 12 months of follow-up, RSA showed a significant higher anterior elevation (105 degrees vs. 80 degrees, P = 0.002 and 110 degrees vs. 90 degrees, P = 0.02, respectively) and constant score (60 vs. 41, P = 0.01 and 51 vs. 32, P = 0.05, respectively) compared with HA. There were no significant differences in external and internal rotation. Also, visual analog scale pain, DASH scores, SF-12 scores, and radiological healing of the tuberosities and heterotopic ossification did not show any significant differences between groups. CONCLUSION RSA showed significant superior functional outcomes for anterior elevation and constant score compared with HA for dislocated 3-part and 4-part proximal humerus fractures after short-term follow-up. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Niels Laas
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Yde Engelsma
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Frans J A Hagemans
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Max A Hoelen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands ; and
| | - Derek F P van Deurzen
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Hospital, Amsterdam, the Netherlands
| | - Bart J Burger
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Iijima Y, Sasanuma H, Saito T, Nakama S, Takeshita K. A case of simultaneous bilateral reverse shoulder arthroplasty for bilateral comminuted proximal humerus fractures in an elderly patient. JSES Int 2021; 5:688-691. [PMID: 34223416 PMCID: PMC8245984 DOI: 10.1016/j.jseint.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yuki Iijima
- Jichi Medical University, Department of Orthopaedic Surgery, Shimotsuke, Tochigi, Japan
| | - Hideyuki Sasanuma
- Tochigi Medical Center Shimotsuga, Department of Orthopaedic Surgery, Ohira, Tochigi, Japan
| | - Tomohiro Saito
- Jichi Medical University, Department of Orthopaedic Surgery, Shimotsuke, Tochigi, Japan
| | - Sueo Nakama
- Tochigi Medical Center Shimotsuga, Department of Orthopaedic Surgery, Ohira, Tochigi, Japan
| | - Katsushi Takeshita
- Jichi Medical University, Department of Orthopaedic Surgery, Shimotsuke, Tochigi, Japan
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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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Schwarz AM, Hohenberger GM, Sauerschnig M, Niks M, Lipnik G, Mattiassich G, Zacherl M, Seibert FJ, Plecko M. Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience. BMC Musculoskelet Disord 2021; 22:48. [PMID: 33419418 PMCID: PMC7792308 DOI: 10.1186/s12891-020-03903-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA). METHODS This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals). RESULTS Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings. CONCLUSIONS RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- A M Schwarz
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria.
| | - G M Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - M Sauerschnig
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - M Niks
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - G Lipnik
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - G Mattiassich
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - M Zacherl
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - F J Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - M Plecko
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
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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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Barros LH, Figueiredo S, Marques M, Rodrigues C, Ramos J, Claro R. Consolidação dos tubérculos na artroplastia reversa do ombro após fratura proximal do úmero: Existe melhoria nos resultados funcionais? Rev Bras Ortop 2020; 55:748-754. [PMID: 33364654 PMCID: PMC7748945 DOI: 10.1055/s-0039-3402459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/15/2019] [Indexed: 11/09/2022] Open
Abstract
Objective
To compare the functional results of patients with complex proximal humerus fracture submitted to total shoulder reverse arthroplasty with and without tuberosity healing. The secondary goal was to know the tuberosity healing rate after reverse shoulder arthroplasty with our surgical technique.
Methods
A retrospective, cohort type study, with a prospective database collection. In total, 28 patients fulfilled the inclusion criteria: age ≥ 65 years, reverse shoulder arthroplasty for complex proximal humerus fracture (type-3 or -4, according to Neer), and a minimum of 24 months of follow-up. At six months of follow-up, all of the patients were evaluated radiographically for tuberosity, and then they were divided into 2 groups: those with healed tuberosities and those with non-healed tuberosities. A clinical evaluation using the Constant score, active range of motion and the Visual Analog Scale (VAS) at the last follow-up was also performed.
Results
Tuberosity healing occurred in 21 patients (76.3%). There were statistically significant differences in the Constant scoring system (
p
< 0.001), forward elevation (
p
= 0.020), internal rotation (
p
= 0.001) and external rotation (
p
= 0.003) when comparing the group of healed tuberosities with the group of non-healed tuberosities. No differences were found regarding the VAS score.
Conclusion
Tuberosity healing results in an improvement of the functional outcomes of patients submitted to reverse shoulder arthroplasty as a treatment for complex proximal humeral fractures in the elderly.
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Affiliation(s)
- Luís Henrique Barros
- Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Sérgio Figueiredo
- Departamento de Ortopedia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Manuel Marques
- Departamento de Ortopedia, Centro Hospitalar do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Claudia Rodrigues
- Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Joaquim Ramos
- Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Rui Claro
- Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Hess F, Bohnert L, Jaberg L, Welter J, Pape HC, Sireus A. Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis. INTERNATIONAL ORTHOPAEDICS 2020; 44:2711-2717. [PMID: 33057765 DOI: 10.1007/s00264-020-04831-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The use of reverse shoulder arthroplasty (RSA) to treat complex humerus fractures is increasing, especially in older, osteoporotic patients. Refixation and tuberosity healing are needed to achieve an optimal range of motion (ROM), external rotation, active forward elevation, and patient satisfaction. Proper healing has been reported, however, in only 40-84% of cases. Our study's aim was to describe a simple, reproducible fixation technique designed to improve tuberosity healing. METHODS We included 30 patients with acute proximal humerus fractures undergoing RSA (Global Unite Reverse Fracture, DePuy Synthes, Warsaw, IN, USA) with tuberosity reattachment. The humerus stem was cemented in 24 cases. A standardized suture technique with two fiber tapes was used to reattach tuberosities. Clinical and radiological parameters, which were collected one year post-operatively, included ROM, pain level, Constant scores, subjective shoulder value (SSV), and tuberosity healing. RESULTS The mean age of the patients was 79.3 years (± 7; range 65-92), and the tuberosity healing rate was 90.0% (27 of 30). Two patients showed migration (one nonunion, one malunion), and another had complete resorption after an initial period of proper healing. Radiolucent lines around the humerus stem occurred in one case, and three patients had scapular notching. The mean SSV was 86% (± 11; range 60-100), the Constant score was 72 (± 10.3; range 48-92), the active forward flexion was 140° (± 14.3; range 115-165), and external rotation was 23° (± 16.5; range 0-50). CONCLUSIONS This reattachment technique, which is simple and reproducible, achieved a higher tuberosity healing rate than previously published rates.
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Affiliation(s)
- Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
| | - Laurent Bohnert
- Department of Orthopedic Surgery, Cantonal Hospital Lucerne, Sursee, Switzerland
| | - Laurenz Jaberg
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - JoEllen Welter
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | | | - Andrea Sireus
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
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