Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty

被引:103
作者
Gallinet, David [1 ]
Adam, Antoine [2 ]
Gasse, Nicolas [2 ]
Rochet, Severin [2 ]
Obert, Laurent [2 ]
机构
[1] St Vincent Private Hosp, Besancon, France
[2] Univ Hosp Jean Minjoz, Orthoped Traumatol Plast & Hand Surg Unit, Besancon, France
关键词
Reverse shoulder arthroplasty; hemiarthroplasty; shoulder fracture; tuberosity repair; rotation; PROXIMAL HUMERAL FRACTURES; FOLLOW-UP; PRIMARY HEMIARTHROPLASTY; INTERNAL-FIXATION; PROSTHESIS; MULTICENTER; OUTCOMES; 3-PART; PLATE; HEAD;
D O I
10.1016/j.jse.2012.03.011
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Hypothesis: Reverse shoulder arthroplasty in complex shoulder fractures is now a common practice. Unfortunately, loss of rotation is observed when tuberosity excision is used, impairing function and patient satisfaction. The purpose of this study was to evaluate the advantage of tuberosity repair in terms of the functional result. Materials and methods: We reviewed 41 patients, with a mean age at trauma of 76.9 years, at a mean follow-up of 24 months. Tuberosities were repaired in 27 patients and totally removed in the other 14 cases. Results: Two-thirds of the repaired tuberosities consolidated in anatomic position. We compared a group with tuberosity healing in anatomic position versus a group without repair and with malunion or nonunion of the tuberosities. In the first group, all sectors of motion, especially external rotation (49 degrees vs 10 degrees), were improved and both Constant scores (65 vs 50) and Disabilities of the Arm, Shoulder and Hand scores (30 vs 40) were significantly better. Conclusion: Management of complex fractures of the superior extremity of the humerus by reverse shoulder arthroplasty is an accepted approach, but such treatment is restricted to elderly patients. Shoulder rotational ability is improved by systematically repairing the tuberosities around the implant. However, their consolidation should be anatomic; otherwise, the result is impaired by the lack of rotation. Nonunion or malunion does not lead to a functional disaster, as is sometimes the case with hemiarthroplasty without tuberosity healing.
引用
收藏
页码:38 / 44
页数:7
相关论文
共 35 条
[1]   The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail [J].
Adedapo, AO ;
Ikpeme, JO .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2001, 32 (02) :115-121
[2]   Shoulder hemiarthroplasty for acute fractures of the proximal humerus: A minimum five-year follow-up [J].
Antuna, Samuel A. ;
Sperling, John W. ;
Cofield, Robert H. .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2008, 17 (02) :202-209
[3]  
Bauer Otto, 2009, Orvosi Hetilap, V150, P2237, DOI 10.1556/OH.2009.28717
[4]  
BENGNER U, 1988, CLIN ORTHOP RELAT R, P179
[5]   Tuberosity malposition and migration:: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus [J].
Boileau, P ;
Krishnan, SG ;
Tinsi, L ;
Walch, G ;
Coste, JS ;
Molé, D .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2002, 11 (05) :401-412
[6]   Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: As an isolated procedure or with a reverse arthroplasty [J].
Boileau, Pascal ;
Chuinard, Christopher ;
Roussanne, Yannick ;
Neyton, Lionel ;
Trojani, Christophe .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2007, 16 (06) :671-682
[7]   Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly - A prospective review of 43 cases with a short-term follow-up [J].
Bufquin, T. ;
Hersan, A. ;
Hubert, L. ;
Massin, P. .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2007, 89B (04) :516-520
[8]   Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up [J].
Cazeneuve, J. -F. ;
Cristofari, D. -J. .
REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L APPAREIL MOTEUR, 2006, 92 (06) :543-548
[9]   The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly [J].
Cazeneuve, J. -F. ;
Cristofari, D. -J. .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2010, 92B (04) :535-539
[10]   Delta III reverse shoulder arthroplasty: Radiological outcome for acute complex fractures of the proximal humerus in elderly patients [J].
Cazeneuve, J. -F. ;
Cristofari, D. J. .
ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, 2009, 95 (05) :325-329