scholarly journals How to improve the outcomes of surgically treated proximal humeral osteoporotic fractures? A narrative review

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Antonio Benedetto Cecere ◽  
Giuseppe Toro ◽  
Annalisa De Cicco ◽  
Adriano Braile ◽  
Marco Paoletta ◽  
...  
Keyword(s):  
Total Shoulder Arthroplasty ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Shaft Fracture ◽  
Narrative Review ◽  
Fracture Dislocation ◽  
Surgical Indications ◽  
Advantages And Disadvantages ◽  
Varus Angulation ◽  
Reverse Total Shoulder

Proximal humeral fractures (PHF) are the third most common non-vertebral fragility fractures after hip and distal radius. It still controversial which treatment might be more appropriate, and surgically treated outcomes depends also on an appropriate technique. In order to clarify surgical indications, tips and pitfall a narrative review was conducted. Pinning, external fixation, plating and internal fixators has each one its advantages and disadvantages. During the procedure an appropriate use of the fixation device and handling of the soft tissue might be associated with better outcomes. Calcar comminution, varus angulation, medial dislocation of the shaft, fracture-dislocation are factors that could lead to choose a replacement. Hemiarthroplasty and reverse total shoulder arthroplasty are the most common prosthesis used in PHF. The restoration of humeral length and tuberosities might lead to an improvement in clinical outcomes and prosthesis survivorship.

scholarly journals Reverse Total Shoulder Arthroplasty for Geriatric Proximal Humerus Fracture Dislocation With Concomitant Nerve Injury

2019 ◽  
Vol 10 ◽  
pp. 215145931985531 ◽  
Author(s):  
Gregory Gasbarro ◽  
Jared A. Crasto ◽  
Jorge Rocha ◽  
Sarah Henry ◽  
Daiji Kano ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Shoulder Arthroplasty ◽  
Nerve Palsy ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Fracture Dislocation ◽  
Inclusion Criteria ◽  
Fracture Dislocations ◽  
Reverse Total Shoulder

Introduction: Preoperative axillary nerve palsy is a contraindication to reverse total shoulder arthroplasty (rTSA) due to the theoretical risk of higher dislocation rates and poor functional outcomes. Treatment of fracture-dislocations of the proximal humerus with rTSA is particularly challenging, as these injuries commonly present with concomitant neurologic and soft tissue injury. The aim of the current study was to determine the efficacy of rTSA for this fracture pattern in geriatric patients presenting with occult or profound neurologic injury. Methods: A retrospective case series of all shoulder arthroplasty procedures for proximal humerus fractures from February 2006 to February 2018 was performed. Inclusion criteria were patients aged greater than 65 years at the time of surgery, fracture-dislocations of the proximal humerus, and treatment with rTSA. Patients with preoperative nerve injuries were compared to patients without overt neurologic dysfunction. Forward elevation, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analog Scale (VAS), and Subjective Shoulder Value (SSV) were obtained at final follow-up. Results: Forty-six rTSA for acute fracture were performed during the study period, 16 patients met the inclusion criteria and 5 (31%) presented with overt preoperative nerve injuries. At mean 3.1 years follow up, there were no postoperative complications including dislocations and final forward elevation was similar between study groups. Patients with overt nerve palsy had higher QuickDASH and VAS scores with lower SSV and self-rated satisfaction. Discussion: In the majority of patients with or without overt nerve injury, rTSA reliably restored overhead function and led to good or excellent patient-rated treatment outcomes. Overt nerve palsy did not lead to higher complication rates, including dislocation. Despite greater disability and less satisfaction, complete or partial nerve recovery can be expected in the majority of patients. Conclusion: Nerve injury following proximal humeral fracture dislocation may not be an absolute contraindication to rTSA.

scholarly journals Heterotopic Ossification of the Brachial Plexus After Reverse Total Shoulder Arthroplasty

2018 ◽  
Vol 2 ◽  
pp. 247154921880777 ◽  
Author(s):  
Patrick K Riggle ◽  
Brett G Brazier ◽  
C Luke Wilcox
Keyword(s):  
Brachial Plexus ◽  
Heterotopic Ossification ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus Fracture ◽  
Axillary Artery ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Fracture Dislocation ◽  
Brachial Plexopathy ◽  
Reverse Total Shoulder

In the following report, we present the case of a patient who presented with a proximal humerus fracture dislocation and an associated brachial plexopathy. After undergoing a reverse total shoulder arthroplasty, the brachial plexopathy showed signs of improvement plateaued until the patient started having increased pain in the involved extremity and the brachial plexopathy began to worsen. At that time, it was discovered that the patient had heterotopic ossification (HO) encasing the brachial plexus and axillary artery. To our knowledge, this is the first reported case of HO involving the brachial plexus and axillary artery.

Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

2021 ◽  
pp. 175857322110193
Author(s):  
Arjun K Reddy ◽  
Jake X Checketts ◽  
B Joshua Stephens ◽  
J Michael Anderson ◽  
Craig M Cooper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Revisional Surgery ◽  
Total Shoulder Arthroplasty ◽  
Surgical Site Infections ◽  
Total Sample ◽  
Reverse Total Shoulder Arthroplasty ◽  
Common Complication ◽  
Humeral Component ◽  
Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

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