Cementless and locked prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: prospective clinical evaluation of hemi- and reverse arthroplasty

Abstract

In this population of elderly patient, new fall with periprosthetic fracture or infection led the surgeon to remove the stem. At shoulder level, the removal of a cemented stem remains a highly demanding procedure with sometimes bad functional results and elevated level of complications. This series is the first one of locked stem without significant complications. Locked stem remains a new but logical tool in trauma.

Hemi- vs. reverse shoulder arthroplasty for acute proximal humeral fractures

“…The nine selected articles were published between 2011 and 2016, four of which were level I studies according to their level of evidence statements [2,6,28,32,37], three of which were level II studies according to their level of evidence statements [3,8,11,22], and the remaining two were deemed to be level II studies, although they did not explicitly state the level of evidence ( [2,6,28,32,37]; . Table 2).…”

“…Table 2). Only three studies [3,11,32] directly compared outcomes of acute PHF treated by HSA versus RSA. The remaining six studies compared outcomes of acute PHF treated by conventional HSA versus HSA + biceps tenodesis [37], trabecular metal HSA [22], in-…”

“…The cohort sizes ranged from 12 to 69 patients per group while the mean follow-up ranged from 1 to 4.6 years. The mean patient age was >70 years in six studies [2,3,6,11,28,32], between 60 and 70 years in two studies [8,22], and between 50 and 55 years in one study [37].…”

“…On a scale of -2 (poorest) to 5 (highest) for quality assessment [19], of the four level I studies, three scored 3 points [2,28,32] and one scored 5 points [37]. On a scale of 0 to 24, of the four prospective level II studies, one scored 15 points [3], one 17 points [8], one 21 points [6], and two 23 points [11,22].…”

“…4), the Disability of the Arm, Shoulder and Hand (DASH) Score [17], the University of California-Los Angeles (UCLA) Score [14], and the American Shoulder and Elbow Surgeon (ASES) Score [25]. Forward flexion [2,3,8,11,22,32,37] and external rotation [2,3,6,8,11,22,32] were each reported in seven articles, while internal rotation was reported in four articles [2,8,22,32], and abduction was reported in four articles [2,3,8,32]. Five studies [2,11,22,28,32] reported tuberosity malunion or resorption.…”