Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical not
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ORIGINAL PAPER
Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis Florian Hess 1
&
Laurent Bohnert 2 & Laurenz Jaberg 1 & JoEllen Welter 1 & Hans-Christoph Pape 3 & Andrea Sireus 1
Received: 23 April 2020 / Accepted: 22 September 2020 # SICOT aisbl 2020
Abstract Purpose The use of reverse shoulder arthroplasty (RSA) to treat complex humerus fractures is increasing, especially in older, osteoporotic patients. Refixation and tuberosity healing are needed to achieve an optimal range of motion (ROM), external rotation, active forward elevation, and patient satisfaction. Proper healing has been reported, however, in only 40–84% of cases. Our study’s aim was to describe a simple, reproducible fixation technique designed to improve tuberosity healing. Methods We included 30 patients with acute proximal humerus fractures undergoing RSA (Global Unite Reverse Fracture, DePuy Synthes, Warsaw, IN, USA) with tuberosity reattachment. The humerus stem was cemented in 24 cases. A standardized suture technique with two fiber tapes was used to reattach tuberosities. Clinical and radiological parameters, which were collected one year post-operatively, included ROM, pain level, Constant scores, subjective shoulder value (SSV), and tuberosity healing. Results The mean age of the patients was 79.3 years (± 7; range 65–92), and the tuberosity healing rate was 90.0% (27 of 30). Two patients showed migration (one nonunion, one malunion), and another had complete resorption after an initial period of proper healing. Radiolucent lines around the humerus stem occurred in one case, and three patients had scapular notching. The mean SSV was 86% (± 11; range 60–100), the Constant score was 72 (± 10.3; range 48–92), the active forward flexion was 140° (± 14.3; range 115–165), and external rotation was 23° (± 16.5; range 0–50). Conclusions This reattachment technique, which is simple and reproducible, achieved a higher tuberosity healing rate than previously published rates. Keywords Reverse shoulder arthroplasty . Proximal humerus fracture . Tuberosities . Refixation technique
Introduction Proximal humerus fractures are common fracture patterns, especially in older women with osteoporosis who have had a low-energy trauma [1–3]. Most fractures can be treated conservatively with satisfactory long-term functional and quality-
* Florian Hess [email protected] 1
Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
2
Department of Orthopedic Surgery, Cantonal Hospital Lucerne, Sursee, Switzerland
3
Department of Trauma Surgery, University of Zurich, Zurich, Switzerland
of-life outcomes [4]. Reverse shoulder arthroplasty (RSA) is, however, being used more often to treat these complex fractures [5–12]. This surgical option presents some challenges though. RSA aims to improve the deltoid lever arm’s function, which includes enhanced forward flexion and abduction by
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