nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

11.03.2020 | Original Article

Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

verfasst von: Jonas Schmalzl, Malik Jessen, Malte Holschen, Brian C. Cohen, Jörn Steinbeck, Lars-Johannes Lehmann, Patrick J. Denard

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures (PHFs) in the elderly. This study evaluates the influence of tuberosity healing (TH) on functional outcome following a 135° humeral inclination RSA for PHFs.

Methods

Retrospectively, all patients with an acute PHF treated with a 135° humeral inclination RSA at four centers during a three-year period were followed up. Constant score (CS), TH and glenoid notching were analyzed.

Results

Sixty-four of 100 patients (64%) with a mean age of 76 ± 7 years were available for follow-up at 22 ± 8 months. The mean-adjusted CS was 72%. TH of the greater tuberosity (GT) was 77% and resulted in significantly improved forward flexion (128° vs. 92°; p = 0.003), external rotation (33° vs. 17°; p = 0.03) and adjusted CS (78% vs. 54%, p < 0.005). GT healing rate was 86% with neutral, 70% with lateralized and 33% with an inferior eccentric glenosphere. TH of the lesser tuberosity was 79%. There was 8% complication and 3% revision rate; implant survival was 100%.

Conclusion

RSA with 135° humeral inclination for PHFs leads to good functional outcome, reproducible results and a high rate of TH. The short-term revision rate is low. TH is associated with improved ROM and functional outcome.

Level of evidence

III.

Murray IR, Amin AK, White TO, Robinson CM (2011) Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Jt Surg Br 93:1–11. https://doi.org/10.1302/0301-620X.93B1.25702 CrossRef

Ockert B (2019) Die komplexe proximale Humerusfraktur. Obere Extremität 14:83–92. https://doi.org/10.1007/s11678-019-0510-8 CrossRef

Bastian JD, Hertel R (2009) Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elb Surg 18:216–219. https://doi.org/10.1016/j.jse.2008.09.015 CrossRef

Krause FG, Huebschle L, Hertel R (2007) Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties done for proximal humeral fractures with cable wire and bone graft: 58 patients with a 22-month minimum follow-up. J Orthop Trauma 21:682–686. https://doi.org/10.1097/BOT.0b013e31815917e0 CrossRefPubMed

Reineck JR, Krishnan SG, Burkhead WZ (2007) Four-part proximal humerus fractures: evaluation and treatment. Hand Clin 23:415–424. https://doi.org/10.1016/j.hcl.2007.09.006 CrossRefPubMed

Kettler M, Biberthaler P, Braunstein V et al (2006) Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures. Unfallchirurg 109:1032–1040CrossRef

Warnhoff M, Lill H, Jensen G et al (2019) Proximale Humerusfraktur – was sagt die aktuelle Literatur? Obere Extremität 14:9–17. https://doi.org/10.1007/s11678-018-0496-7 CrossRef

Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Jt Surg 95:2050–2055. https://doi.org/10.2106/JBJS.L.01637 CrossRef

Gallinet D, Clappaz P, Garbuio P et al (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95:48–55. https://doi.org/10.1016/j.otsr.2008.09.002 CrossRefPubMed

10.

Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures: a blinded, randomized, controlled, prospective study. J Shoulder Elb Surg 23:1419–1426. https://doi.org/10.1016/j.jse.2014.06.035 CrossRef

11.

Lévigne C, Boileau P, Favard L et al (2008) Scapular notching in reverse shoulder arthroplasty. J Shoulder Elb Surg 17:925–935. https://doi.org/10.1016/j.jse.2008.02.010 CrossRef

12.

Worland RL, Kim DY, Arredondo J (1999) Periprosthetic humeral fractures: management and classification. J Shoulder Elb Surg 8:590–594CrossRef

13.

Crosby LA, Hamilton A, Twiss T (2011) Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res 469:2544–2549. https://doi.org/10.1007/s11999-011-1881-3 CrossRefPubMedPubMedCentral

14.

Demirhan M, Kilicoglu O, Altinel L et al (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:181–189CrossRef

15.

Boileau P, Krishnan SG, Tinsi L et al (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elb Surg 11:401–412CrossRef

16.

Neer CS 2nd (1955) Indications for replacement of the proximal humeral articulation. Am J Surg 89:901–907CrossRef

17.

Greiner SH, Diederichs G, Kröning I et al (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elb Surg 18:431–436. https://doi.org/10.1016/j.jse.2008.10.007 CrossRef

18.

Torrens C, Alentorn-Geli E, Mingo F et al (2018) Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: influence of greater tuberosity healing on the functional outcomes. J Orthop Surg 26:230949901876013. https://doi.org/10.1177/2309499018760132 CrossRef

19.

Chun YM, Kim DS, Lee DH, Shin SJ (2017) Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: Can a healed tuberosity improve the functional outcomes? J Shoulder Elb Surg 26:1216–1221. https://doi.org/10.1016/j.jse.2016.11.034 CrossRef

20.

Gallinet D, Adam A, Gasse N et al (2013) Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Shoulder Elb Surg 22:38–44. https://doi.org/10.1016/j.jse.2012.03.011 CrossRef

21.

Ohl X, Bonnevialle N, Gallinet D et al (2018) How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. J Shoulder Elb Surg 27:2139–2144. https://doi.org/10.1016/j.jse.2018.05.030 CrossRef

22.

Schmalzl J, Jessen M, Sadler N, Lehmann LJ, Gerhardt C (2020) High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis. BMC Musculoskelet Disord. 21(1):35CrossRef

Titel: Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis
verfasst von: Jonas Schmalzl
Malik Jessen
Malte Holschen
Brian C. Cohen
Jörn Steinbeck
Lars-Johannes Lehmann
Patrick J. Denard
Publikationsdatum: 11.03.2020
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 5/2020
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02649-8

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Abstract

Introduction

Methods

Results

Conclusion

Level of evidence

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusion

Level of evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2020

Clinical and radiological outcomes of total joint arthroplasty in patients with ochronotic arthropathy

Intraoperative bacterial contamination in total hip and knee arthroplasty is associated with operative duration and peeling of the iodine-containing drape from skin

Management of distal humerus fractures

Percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fractures in children

Risk factors for developing acute compartment syndrome in the pediatric population: a systematic review and meta-analysis

Surgical versus conservative treatment for first patellofemoral dislocations: a meta-analysis of clinical trials

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie