Posttraumatic changes of the proximal humerus: Malunion, nonunion, and osteonecrosis. Treatment with modular hemiarthroplasty or total shoulder arthroplasty

Bipolar Salvage Shoulder Arthroplasty

“…The patients were so severely disabled that preoperative testing of function and strength was meaningless. Therefore only range of motion and pain were assessed, both before and after operation, using the Hospital for Special Surgery (HSS) scoring system modified to exclude function and muscle strength (Table II; Dines et al 1993). In this system 30 points were allocated for lack of pain and 25 for range of movement, a normal shoulder scoring 55.…”

“…Gross destruction of the humeral head with severe damage to the rotator cuff is an unusual and crippling cause of shoulder symptoms (Dines et al 1993). Since the degree of damage is too severe to allow conventional replacement arthroplasty such patients are often offered an arthrodesis or an excision arthroplasty (Kraulis and Hunter 1976;Clifford 1981;Tanner and Cofield 1983;Hawkins and Angelo 1987;Cofield 1988).…”

Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups

“…Treatment of post-traumatic fracture sequelae of the proximal part of the humerus with malunion of the tuberosities is a challenge for any shoulder surgeon. Even when technically achieved, the published results are often unsatisfactory with anatomic replacement 2,4,28 . On the basis of the negative experience with anatomic shoulder arthroplasty, we prefer re- © C I C E d i z i o n i I n t e r n a z i o n a l i verse shoulder arthroplasty for this condition and results can improve with a careful but intense rehabilitation, as we show in our Group C findings (Fig.…”

“…Recently, indications became wider allowing the management of different shoulder diseases. RSA, firstly was indicated for pseudoparalitic shoulders with massive rotator cuff tears (MRCT); has been published that RSA may have good results even in acute fractures in aged patients, rotator cuff tears arthropathy (CTA), primary osteoarthritis (OA), gleno-humeral rheumatoid arthritis (RA), fractures sequelae and, in glenoid excessive retroversion and humeral head static subluxation in good cuff status shoulders [1][2][3][4][5][6][7][8][9] , resulting in significant and predictable pain relief and restoration of active elevation by the medialization of the center of rotation and lowering of the humerus, with durable efficiency 1 . Due to modified biomechanics and constraints of gleno-humeral joint, complications after RSA seem to be about 4-fold more than anatomic total shoulder arthroplasty and hemiarthroplasty at mid-term follow up [10][11][12] .…”

Stemless shoulder prosthesis for treatment of proximal humeral malunion does not require tuberosity osteotomy

“…Inserting a classic stemmed prosthesis can be difficult or even impossible in some cases without performing tuberosity osteotomy. In the literature, greater tuberosity osteotomy was required in 11 % [2] to 60 % [4] of cases. Because an osteotomy makes the surgery more difficult and increases the potential for complications, some authors recommend tolerating the distorted anatomy of the proximal humerus and adapting the prosthesis to the modified anatomy [1,2,5].…”