Delta III reverse shoulder arthroplasty in the treatment of complex 3- and 4-part fractures of the proximal humerus: 6 to 42 months of follow up

Abstract

BackgroundThere is a growing tendency for complex proximal humerus fractures (PHF) in osteoporotic patients to be treated with reverse shoulder arthroplasty (RSA). It has been proposed that RSA has more benefits than other treatment options. The aim of our study was to investigate preoperative characteristics as well as clinical and radiological outcomes in patients with complex 3- or 4-part PHF who had undergone primary RSA.MethodsPatients with a minimum follow-up of 6 months who had undergone a primary RSA after 3- or 4-part PHF in the period between 2008 and 2011 were eligible for the study. Clinical records, X-rays and CT-scans were investigated and a clinical examination was performed. Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant-Murley score (CMS) were calculated. Sixteen patients were examined as part of the study. The mean follow-up was 20 months (range 6-42 months). According to Codman-Hertel classification we encountered 15 Hertel “12” and 1 Hertel “8” type fractures.ResultsThirty-two patients (27 female – 84.4%) with a mean age of 72 years underwent operations to treat complex 3- and 4-part fractures of the proximal humerus. Sixteen patients were reexamined. In 14 cases the dominant upper extremity was on the right, in 2 cases it was on the left, in 6 cases the right side was affected and in 10 cases the left side was affected. The mean CMS was 54.8 (range 18-95) and the mean DASH was 37.5 (range 2.9-81). A trend was established between the CMS and dominance of the affected shoulder. The CMS was better if the affected shoulder was on the non-dominant side (p-value 0.051). No statistical difference was noted between age and clinical outcome.ConclusionsOur mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA. RSA can provide immediate relief and good shoulder function in elderly patients. Nevertheless, the question of longevity of these implants remains to be observed.

Complications of Shoulder Arthroplasty

“…Raiss et al demonstrated a reduction in survivorship at 10 and 15 years after TSA performed with cement secondary to pain and implant loosening; revision procedures occurred at a mean of 8.8 years from the date of implantation 125 . The five RSA studies with minimum follow-up of 5 years noted scapular notching and instability as the most common complications 28 [33][34][35][36][37][38][39][44][45][46][47][48]50,51,53,54,[56][57][58][59]61,64,65,67,69,70,73,75,79,81,[88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]104,105,…”

Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: A case report

“…Klein et al [32] achieved a similar CMS of 68, although the tuberosities were excised in all patients. Mattiassich et al [33] reported a mean CMS of 54.8 (range 18–95) and a mean DASH score of 37.5 (range 2.9–81) in 32 patients with a mean age of 72 years and treated with primary RSA after four-part fractures of the proximal humerus. Also, our result is aligned to staged bilateral RSA not performed in the acute traumatic setting [[34], [35], [36], [37], [38], [39]].…”

Die osteoporotische Humeruskopffraktur

“…6). Die Vorteile dieser Technik im Vergleich zum Kopferhalt liegen v. a. in der schnellen Reduktion der Schmerzsymptomatik und der geringen Revisionsrate [46,50].…”