Proximal humeral malunion treated with reverse shoulder arthroplasty

Background: The purpose of this study was to determine the outcomes of patients with proximal humeral malunions treated with reverse shoulder arthroplasty (RSA). Materials and methods: Sixteen patients were treated with RSA for sequelae of a proximal humeral fracture with a malunion. Clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score, Simple Shoulder Test, visual analog scale [VAS] score for pain and function, range of motion, and patient satisfaction) and radiographs were evaluated at a minimum follow-up of 2 years. Wilcoxon signed-rank tests were used to analyze preoperative and postoperative data. Results: All patients required alteration of humeral preparation with increased retroversion of greater than 30 degrees. The total ASES score improved from 28 to 63 (P=.001), ASES pain score from 15 to 35 (P=.003), ASES functional score from 15 to 27 (P=.015), VAS pain score from 7 to 3 (P=.003), VAS function score from 0 to 5 (P=.001), and Simple Shoulder Test score from 1 to 4 (P=.0015). Forward flexion improved from 53 degrees to 105 degrees (P=.002), abduction from 48 degrees to 105 degrees (P=.002), external rotation from 5 degrees to 30 degrees (P=.015), and internal rotation from S1 to L3 (P=.005). There were no major complications reported. Postoperative radiographic evaluation showed 2 patients with evidence of notching and 1 patient with proximal humeral bone resorption. Conclusion: RSA is indicated for treating the most severe types of proximal humeral fracture sequelae. The results of RSA for proximal humeral malunions with altered surgical technique yield satisfactory outcomes in this difficult patient population. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.