Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis
- 1 December 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 44 (12), 2711-2717
- https://doi.org/10.1007/s00264-020-04831-3
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 degrees (+/- 14.3; range 115-165), and external rotation was 23 degrees (+/- 16.5; range 0-50). Conclusions This reattachment technique, which is simple and reproducible, achieved a higher tuberosity healing rate than previously published rates.Keywords
This publication has 34 references indexed in Scilit:
- The initial treatment of complex proximal humerus fracture affects the outcome of revision with reverse shoulder arthroplastyInternational Orthopaedics, 2020
- Functional and quality of life outcome after non-operatively managed proximal humeral fracturesJournal of Orthopaedics and Traumatology, 2017
- The Epidemiology of Upper Extremity Fractures in the United States, 2009Journal of Orthopaedic Trauma, 2015
- Delta III reverse shoulder arthroplasty: Radiological outcome for acute complex fractures of the proximal humerus in elderly patientsOrthopaedics & Traumatology: Surgery & Research, 2009
- Three or four parts complex proximal humerus fractures: Hemiarthroplasty versus reverse prosthesis: A comparative study of 40 casesOrthopaedics & Traumatology: Surgery & Research, 2009
- Treatment of Comminuted Fractures of the Proximal Humerus in Elderly Patients With the Delta III Reverse Shoulder ProsthesisJournal of Orthopaedic Trauma, 2008
- Reverse Shoulder Arthroplasty for the Treatment of Proximal Humeral FracturesHand Clinics, 2007
- Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderlyThe Journal of Bone and Joint Surgery. British volume, 2007
- Basic Epidemiology of Fractures of the Upper and Lower Limb among Americans over 65 Years of AgeEpidemiology, 1996
- The epidemiology of peripheral fracturesBone, 1996