Treatment of Comminuted Fractures of the Proximal Humerus in Elderly Patients With the Delta III Reverse Shoulder Prosthesis

Klein, Michael; Juschka, Miriam; Hinkenjann, Bernd; Scherger, Bernhard; Ostermann, P. A. W.

doi:10.1097/bot.0b013e31818afe40

Cited by 235 publications

(154 citation statements)

References 27 publications

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“…In this series, we found a very high subjective satisfaction rate, with 92% of patients (48 of 52) rating their subjective satisfaction as good or very good, with a mean SSV of 83% and relative CS of 87%, which compares favorably with published data. 4,7,8,16,26,32 The revision rate of 5% (4 of 74 RTSAs) is relatively low compared with other series, and only 3% of shoulders (2 of 74 RTSAs) needed temporary removal of the prosthesis because of infection.…”

Section: Discussionmentioning

confidence: 90%

“…35,46 The primary use of RTSA for acute fractures has been reported in several small single-center series. 4,7,8,11,24,26,39,40,42 Our series reports the outcomes from 2 independent centers using the same implant and technique. We did not find any differences in the primary outcome endpoints of the patients at one center versus the other, so the results were reproducible.…”

Section: Discussionmentioning

confidence: 99%

“…The use of a reverse total shoulder replacement (reverse total shoulder arthroplasty [RTSA]) as proposed by Grammont et al 19 is an alternative that addresses the additional fragility of the rotator cuff and has shown promising results in a few case series. 4,[7][8][9]11,12,24,26,32,40 It appears established that reattachment of the greater tuberosity yields a better functional outcome than resection of the greater tuberosity.…”

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confidence: 99%

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Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Grubhofer

Wieser

Meyer

et al. 2016

Journal of Shoulder and Elbow Surgery

132

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Due to the aging population with poor bone quality the frequency of complex proximal humerus fractures increases. An operative reconstruction and internal fixation is very challenging and is not always possible. Secondary impaction, screw perforations and humeral head necrosis is a common complication. The use of a Reverse Total Shoulder Arthroplasty in the elderly after trauma is a promising alternative. The present multicenter study retrospectively analyzes our long-term experience of reverse total shoulder arthroplasty as a primary treatment in this patient population regarding pain, range of shoulder motion, subjective shoulder value, the constant score, scapular notiching and signs of loosening. Background: Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Methods: Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). Results: There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. Conclusion:The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Level of evidence: Level IV; Case Series; Treatment Study

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Grubhofer

Wieser

Meyer

et al. 2016

Journal of Shoulder and Elbow Surgery

132

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“…Aus den tuberkelbedingten Komplikationen resultierte die zunehmende Empfehlung zur Implantation einer primären inversen Frakturprothese beim alten Patien- ten (>70 Jahre, [26,34] [52]). …”

Section: Inverse Protheseunclassified

Frakturen des Humeruskopfs

Imrecke

Katthagen

Voigt

et al. 2014

Trauma Berufskrankh

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“…Osteosynthesis may be followed by osteonecrosis, malunion, and soft tissue damage with reduced postoperative mobility. 2,3 The preferred treatment varies depend on the patient's age and bone quality, the expertise of the surgical team and the patients expectation. Although a number of reports have described the outcome of treatment of proximal humeral fractures, comparison of these fractures is hampered by inconsistancy in fracture classification, treatment and evaluation methods.…”

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An evaluation of functional outcome following surgical management of fractures of the proximal humerus with Neer’s scoring system

et al. 2017

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Background: Fractures of the proximal humerus are complex injuries associated with significant morbidity. Various options are available for management including non-operative treatment, depending upon the pattern of the fracture, quality of the bone and the surgeon's familiarity with the techniques. The age of the patient, physical activity and the medical fitness also largely influence the treatment options. The aim of this study was to evaluate the functional outcome following surgical management of these fractures and to compare the results with studies as available in literature.Methods: 30 patients with fractures of the proximal humerus managed by surgical means were studied from January 2012 to January 2014 and were followed up for a minimum period of two years.Results: All the fractures treated united clinically by 8 weeks and radiologically by 16 weeks. There were no cases of delayed or non-union in our series. The fractures were more common in men with a gender distribution of 1.3:1 and were also more common in the age group of 50 to 65 years (53%). As per the Neer’s scoring system, 60% patients had excellent results while 33% patients had satisfactory results. They were all pain free and successfully returned to their pre-injury work. 6% patients had an unsatisfactory result. Conclusions: Surgical management of proximal humerus fractures following the principles of articular surface reconstruction, restoration of the anatomy, stable fixation, with minimal injury to the soft tissues and early mobilization, gives good functional results.

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Treatment of Comminuted Fractures of the Proximal Humerus in Elderly Patients With the Delta III Reverse Shoulder Prosthesis

Cited by 235 publications

References 27 publications

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Frakturen des Humeruskopfs

An evaluation of functional outcome following surgical management of fractures of the proximal humerus with Neer’s scoring system

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