Thursday, July 23, 2015

Failed prosthesis for fracture - salvaged by a reverse total shoulder

Here are some CT scan images of a 73 year old lady with a proximal humeral fracture

Her surgeon attempted a reconstruction with a massive cemented humeral implant. Note the greater tuberosity applied to the metal prosthesis laterally.

She presented to us a year later with pseudo paralysis and with resorption of the tuberosity as shown in the film below.

With difficulty in removing the cemented stem, we were able to convert to a reverse total shoulder.

We saw her yesterday in the office - she said she had no shoulder pain and had active elevation to 150 degrees. Her films are shown below.

Comment: Complex fractures such as this may be best managed by an initial reverse total shoulder rather than attempting an anatomic prosthesis. In cases where a prosthesis was previously cemented, a reverse can be cemented within the existing cement mantle. 


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