Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes

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.

Download Full-text

Reverse Shoulder Arthroplasty Provided Better Functional Outcomes than Hemiarthroplasty for Acute Proximal Humeral Fractures

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.9710.ebo103 ◽

2015 ◽

Vol 97 (10) ◽

pp. 861 ◽

Cited By ~ 8

Author(s):

Lawrence V. Gulotta

Keyword(s):

Shoulder Arthroplasty ◽

Functional Outcomes ◽

Reverse Shoulder Arthroplasty ◽

Proximal Humeral Fractures ◽

Humeral Fractures

Download Full-text

Reverse Total Shoulder Arthroplasty for Treatment of 3- and 4-Part Proximal Humeral Fractures: Clinical and Radiological Analysis With Minimum Follow-Up of 2 Years

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320915321 ◽

2020 ◽

Vol 11 ◽

pp. 215145932091532

Author(s):

Luis Barbosa ◽

Luis Pires ◽

Paulo Rego ◽

Raul Alonso

Keyword(s):

Elderly Patients ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Complication Rates ◽

The Mean ◽

Complex Proximal Humeral Fractures

Background: Hemiarthroplasty has been associated with inferior and unpredictable outcomes when used in the treatment of complex proximal humeral fractures in elderly patients. In this age-group, reverse shoulder arthroplasty is gaining popularity due to the promising results presented in recent evidence. Our aim is to analyze the cases of complex proximal humeral fractures treated by reverse shoulder arthroplasty, regarding functional results and complications. Materials and Methods: Thirty-five fractures from 33 patients with the mean age of 73.5 (65-81) years were treated with reverse shoulder arthroplasty for complex fractures of the proximal humerus. These patients were followed for a mean of 38.3 months (24-68) and analyzed regarding clinical outcomes and complications. Results: The average Quick-Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 6.8 points and 78.3%, respectively. The mean Constant score on the affected side was 64.4 points, 19.5% less than the nonoperated side. The mean active elevation was 123°, abduction 109°, external rotation 38°, and internal rotation 41°. The radiographic tuberosity healing rate was 85.7%. There were no significant differences in outcomes, between patient with healed and reabsorbed tuberosities. Inferior scapular notching was seen in 8 patients. The global complication rate was 12.8%. Conclusion: Reverse shoulder arthroplasty yields good and reproductive results with acceptable complication rates in selected elderly patients with complex proximal humeral fractures.

Download Full-text