Bilateral Reverse Total Shoulder Arthroplasty with Soft Tissue Release for Bilateral Posterior Fracture Dislocation after Status Epilepticus

Proximal humerus fracture is a common orthopedic presentation, with bimodal age distribution. On the other hand, bilateral proximal humerus fracture dislocation is a rarely reported pathology, especially when it is not the result of direct trauma. We present a case of a 71-year-old female patient found to have simultaneous bilateral 4-part proximal humerus fractures following status epilepticus treated surgically with bilateral reverse shoulder arthroplasty with constraint and soft tissue release. In a patient with recurrent status epilepticus episodes, the combination of constrained reverse shoulder arthroplasty and the extensive soft tissue release should decrease the rate of failure and dislocation dramatically. We conclude, after reviewing the literature, that there is no straightforward algorithm for treating such patients and that a clear classification should take into account both bone quality and patient comorbidities which has yet to be developed.

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Nordic Innovative Trials to Evaluate osteoPorotic Fractures (NITEP) Collaboration: The Nordic DeltaCon Trial protocol—non-operative treatment versus reversed total shoulder arthroplasty in patients 65 years of age and older with a displaced proximal humerus fracture: a prospective, randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-024916 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024916 ◽

Cited By ~ 5

Author(s):

Antti P Launonen ◽

Tore Fjalestad ◽

Minna K Laitinen ◽

Tuomas Lähdeoja ◽

Carl Ekholm ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Operative Treatment ◽

Shoulder Arthroplasty ◽

Large Scale ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Controlled Trial ◽

Total Shoulder Arthroplasty ◽

Humerus Fracture ◽

Randomised Controlled

IntroductionThe proximal humerus fracture (PHF) is one of the most common fractures in the elderly. The majority of PHFs are treated non-operatively, while 15%–33% of patients undergo surgical treatment. Recent randomised controlled trial (RCT) and meta-analyses have shown that there is no difference in outcome between non-operative treatment and locking plate or hemi-arthroplasty. During the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity in the treatment of PHF, although there is a lack of RCTs comparing RTSA to non-operative treatment.MethodsThis is a prospective, single-blinded, randomised, controlled, multicentre and multinational trial comparing RTSA with non-operative treatment in displaced proximal humeral fractures in patients 65–85 years. The primary outcome in this study is QuickDASH-score measured at 2 years. Secondary outcomes include visual analogue scale for pain, grip strength, Oxford shoulder score, Constant score and the number of reoperations and complications.The hypothesis of the trial is that operative treatment with RTSA produces better outcome after 2 and 5 years measured with QuickDASH.Ethics and disseminationIn this protocol, we describe the design, method and management of the Nordic DeltaCon trial. The ethical approval for the trial has been given by the Regional Committee for Medical and Health Research Ethics, Norway. There have been several examples in orthopaedics of innovations that result in failure after medium-term follow-ups . In order to prevent such failures and to increase our knowledge of RSTA, we feel a large-scale study of the effects of the surgery on the outcome that focuses on the complications and reoperations is warranted. After the trial 2-year follow-up, the results will be disseminated in a major orthopaedic publication.Trial registration numberNCT03531463; Pre-Results.

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