Thursday, July 28, 2016

Reverse total shoulder in the treatment of proximal humeral malunited fractures

Reverse Shoulder Arthroplasty for Malunions of the Proximal Part of the Humerus (Type-4 Fracture Sequelae)

These authors conducted a retrospective study of 42 shoulders with posttraumatic sequelae of the proximal part of the humerus with malunions of the tuberosities treated with reverse shoulder arthroplasty between 2000 and 2010. The mean age at the time of arthroplasty was 68 years (range, 27 to 83 years; median, 70 years).  The mean clinical and radiographic follow-up was 4 years (range, 2 to 13 years; median, 3.5 years).

The mean Constant score increased from 19.7 points (range, 0 to 52 points) preoperatively to 54.9 points (range, 21 to 83 points) postoperatively (p < 0.0001).
In one case, loosening of the humeral and glenoid components occurred. Scapular notching was present in 22 shoulders (52%) and was grade 1 in 12 cases, grade 2 in 4 cases, grade 3 in 2 cases, and grade 4 in 4 cases. Complications occurred in 4 patients (9.5%): one intraoperative humeral shaft fracture, one traumatic dislocation complicated by an infection, one periprosthetic fracture from a fall, and one aseptic loosening at 13 years after surgery.

Eighteen patients (43%) rated their result as very good, 19 (45%) rated their result as good, 4 (10%) rated their result as satisfactory, and one (2%) rated the result as unsatisfactory.

Comment: The shoulder pathology treated in this series is most challenging. Reverse total shoulder arthroplasty is potentially capable of functional results that cannot be achieved with humeral osteotomy and/or anatomic arthroplasty.