ShoulderReverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly
Section snippets
Materials and methods
In this retrospective study, we performed survivorship, clinical, and radiologic review of all consecutive patients who had RSA for treatment of an acute 3-part or 4-part fracture of the proximal humerus between April 2003 and December 2009.
Patients were included in the study if they were at least 24 months since the date of surgery and the operation was performed by one of the senior authors (M.R. or P.F.R.D.) within 6 weeks of the fracture. For the patients who died, their most recent x-ray
Results
The study comprised 29 RSAs for traumatic humeral fractures in 28 patients.
Discussion
We used the deltopectoral approach because it did not require detachment of the deltoid from the acromion. The deltoid is the primary motor in RSA. This approach also assisted in inferior placement of the glenosphere. Furthermore modified tuberosity fixation is easier through a deltopectoral approach. A further potential benefit of the deltopectoral approach may be the possibility of a lower infection rate. Some previous studies on reverse prostheses have reported a higher infection rate than
Conclusions
This series demonstrates excellent outcomes in the use of a reverse total shoulder arthroplasty for the treatment of 3-part and 4-part fractures in elderly patients. The clinical outcomes of this group were superior to most of the previously published studies and the complication rate was also extremely low, with no dislocations, infections, or prosthetic revisions. We believe that careful attention to the very specific aspects of the surgical technique and rehabilitation that we have used in
Acknowledgment
We thank Dr Richard Page and the shoulder section of the ANJR for provision of data on survivorship.
Disclaimer
The Brisbane Hand and Upper Limb Research Institute receives institutional support from Lima, DePuy, Integra Life Sciences, and LMT, and has received funding from Integra Life Sciences and Lima Corporate.
Mark Ross receives consultancy fees from Integra, LMT, Lima, DePuy, and Arthrex, and receives Speakers Bureau payments from DePuy, Lima, and Integra. Phillip Duke receives consultancy fees from Integra, LMT, Lima and DePuy, and receives Speakers Bureau payments from DePuy and Integra. The other
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Reverse total shoulder arthroplasty for complex proximal humerus fracture in the elderly: clinical and radiological results
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2023, InjuryCitation Excerpt :This data was preferentially obtained from physical therapy visit documentation, as these provided the most precise and standardized values. Achievement of satisfactory functional outcome at final follow up was determined using a previously reported threshold of greater than 90° of active forward flexion [25]. Statistical analysis was performed using Stata/SE® 17.0 for Mac (StataCorp LP, College Station, TX).
The Mater Health Services Human Research Ethics Committee approved this study (Protocol Ref No. 1911E).