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International Orthopaedics

Published in:

01-04-2018 | Original Paper

Anatomical reconstruction to treat acromion fractures following reverse shoulder arthroplasty

Authors: Florian Hess, Ralph Zettl, Daniel Smolen, Christoph Knoth

Published in: International Orthopaedics | Issue 4/2018

Abstract

Purpose

Scapular fractures after reverse shoulder arthroplasty (RSA) are often associated with substantial shoulder impairment. Patient outcomes following either conservative or operative treatment have not been favourable, and consensus is lacking on the best treatment approach. We describe a technique for anatomic reconstruction of fractured lateral and basal acromion in patients at higher risk for diminished function or those for which conservative treatment has already failed.

Methods

Of the 95 patients who underwent RSA at our institution between December 2013 and December 2016, three had post-operative acromion fractures (type II). Two of these patients had secondary dislocation and one underwent conservative treatment that failed. In all three cases, the acromion was reconstructed using an open technique with plate and interfragmentary screw fixation.

Results

After the acromial fracture and prior to reconstructive surgery, the shoulder function decreased substantially in all three cases. Following reconstruction, forward flexion improved from 53.0° to 127°, and abduction improved from 52.0 to 125°. The range of the Constant scores at the one year follow-up was 55-71, and the subjective shoulder value (SSV) was 50-90. One patient reached the same active range of motion (ROM) as her pre-fracture status, and the two other patients improved but did not regain the previous ROM level.

Conclusion

Acromion fractures after RSA are serious complications that have the potential to cause severe shoulder function impairment. Our fixation technique for anatomic lateral and basal acromion reconstruction was used safely to treat three patients with poor shoulder function due to secondary dislocation or non-unions.

Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16(1):65–68PubMed

Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM (2015) Reverse shoulder arthroplasty in the United States: a comparison of National Volume, patient demographics, complications, and surgical indications. Iowa Orthop J 35:1–7

Boileau P, Gonzalez JF, Chuinard C, Bicknell R, Walch G (2009) Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elb Surg 18(4):600–606. https://doi.org/10.1016/j.jse.2009.03.011 CrossRef

Matsen FA 3rd, Boileau P, Walch G, Gerber C, Bicknell RT (2007) The reverse total shoulder arthroplasty. J Bone Joint Surg Am 89(3):660–667CrossRefPubMed

Wall B, Nove-Josserand L, O'Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89(7):1476–1485. https://doi.org/10.2106/JBJS.F.00666 PubMed

Virk MS, Nicholson GP, Romeo AA (2016) Irreparable rotator cuff tears without arthritis treated with reverse total shoulder arthroplasty. Open Orthop J 10:296–308. https://doi.org/10.2174/1874325001610010296

Rittmeister M, Kerschbaumer F (2001) Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elb Surg 10(1):17–22. https://doi.org/10.1067/mse.2001.110515 CrossRef

Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elb Surg 14(1 Suppl S):147S–161S. https://doi.org/10.1016/j.jse.2004.10.006 CrossRef

Gigis I, Nenopoulos A, Giannekas D, Heikenfeld R, Beslikas T, Hatzokos I (2017) Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly. Open Orthop J 11:108–118. https://doi.org/10.2174/1874325001711010108 CrossRefPubMedPubMedCentral

10.

Sebastia-Forcada E, Lizaur-Utrilla A, Cebrian-Gomez R, Miralles-Munoz FA, Lopez-Prats FA (2017) Outcomes of reverse total shoulder arthroplasty for proximal humeral fractures: primary arthroplasty versus secondary arthroplasty after failed proximal humeral locking plate fixation. J Orthop Trauma 31(8):e236–e240. https://doi.org/10.1097/BOT.0000000000000858 CrossRefPubMed

11.

Garcia-Fernandez C, Lopiz-Morales Y, Rodriguez A, Lopez-Duran L, Martinez FM (2015) Periprosthetic humeral fractures associated with reverse total shoulder arthroplasty: incidence and management. Int Orthop 39(10):1965–1969. https://doi.org/10.1007/s00264-015-2972-7 CrossRefPubMed

12.

Raiss P, Edwards TB, Bruckner T, Loew M, Zeifang F, Walch G (2017) Reverse arthroplasty for patients with chronic locked dislocation of the shoulder (type 2 fracture sequela). J Shoulder Elb Surg 26(2):279–287. https://doi.org/10.1016/j.jse.2016.05.028 CrossRef

13.

Statz JM, Schoch BS, Sanchez-Sotelo J, Sperling JW, Cofield RH (2017) Shoulder arthroplasty for locked anterior shoulder dislocation: a role for the reversed design. Int Orthop 41(6):1227–1234. https://doi.org/10.1007/s00264-017-3450-1 CrossRefPubMed

14.

Wierks C, Skolasky RL, Ji JH, McFarland EG (2009) Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res 467(1):225–234. https://doi.org/10.1007/s11999-008-0406-1 CrossRefPubMed

15.

Saltzman BM, Chalmers PN, Gupta AK, Romeo AA, Nicholson GP (2014) Complication rates comparing primary with revision reverse total shoulder arthroplasty. J Shoulder Elb Surg 23(11):1647–1654. https://doi.org/10.1016/j.jse.2014.04.015 CrossRef

16.

Farshad M, Gerber C (2010) Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop 34(8):1075–1082. https://doi.org/10.1007/s00264-010-1125-2 CrossRefPubMedPubMedCentral

17.

Ladermann A, Edwards TB, Walch G (2014) Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop 38(5):991–1000. https://doi.org/10.1007/s00264-013-2175-z CrossRefPubMed

18.

Werner BS, Daggett M, Carrillon Y, Walch G (2015) Evaluation of lengthening in reverse shoulder arthroplasty comparing X-rays and computerised tomography. Int Orthop 39(12):2389–2394. https://doi.org/10.1007/s00264-015-2780-0 CrossRefPubMed

19.

Otto RJ, Virani NA, Levy JC, Nigro PT, Cuff DJ, Frankle MA (2013) Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elb Surg 22(11):1514–1521. https://doi.org/10.1016/j.jse.2013.02.007 CrossRef

20.

Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elb Surg 15(5):527–540. https://doi.org/10.1016/j.jse.2006.01.003 CrossRef

21.

Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br Vol 89(4):516–520. https://doi.org/10.1302/0301-620X.89B4.18435 CrossRef

22.

Crosby LA, Hamilton A, Twiss T (2011) Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res 469(9):2544–2549. https://doi.org/10.1007/s11999-011-1881-3 CrossRefPubMedPubMedCentral

23.

Cuff D, Pupello D, Virani N, Levy J, Frankle M (2008) Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 90(6):1244–1251. https://doi.org/10.2106/JBJS.G.00775 CrossRefPubMed

24.

Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M (2005) The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am 87(8):1697–1705. https://doi.org/10.2106/JBJS.D.02813 PubMed

25.

Hamid N, Connor PM, Fleischli JF, D'Alessandro DF (2011) Acromial fracture after reverse shoulder arthroplasty. Am J Orthop 40(7):E125–E129PubMed

26.

Hattrup SJ (2010) The influence of postoperative acromial and scapular spine fractures on the results of reverse shoulder arthroplasty. Orthopedics 33(5):302. https://doi.org/10.3928/01477447-20100329-04

27.

Wahlquist TC, Hunt AF, Braman JP (2011) Acromial base fractures after reverse total shoulder arthroplasty: report of five cases. J Shoulder Elb Surg 20(7):1178–1183. https://doi.org/10.1016/j.jse.2011.01.029 CrossRef

28.

Walch G, Mottier F, Wall B, Boileau P, Mole D, Favard L (2009) Acromial insufficiency in reverse shoulder arthroplasties. J Shoulder Elb Surg 18(3):495–502. https://doi.org/10.1016/j.jse.2008.12.002 CrossRef

29.

Werner CM, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87(7):1476–1486. https://doi.org/10.2106/JBJS.D.02342 PubMed

30.

Scarlat MM (2013) Complications with reverse total shoulder arthroplasty and recent evolutions. Int Orthop 37(5):843–851. https://doi.org/10.1007/s00264-013-1832-6 CrossRefPubMedPubMedCentral

31.

Teusink MJ, Otto RJ, Cottrell BJ, Frankle MA (2014) What is the effect of postoperative scapular fracture on outcomes of reverse shoulder arthroplasty? J Shoulder Elb Surg 23(6):782–790. https://doi.org/10.1016/j.jse.2013.09.010 CrossRef

32.

Levy JC, Anderson C, Samson A (2013) Classification of postoperative acromial fractures following reverse shoulder arthroplasty. J Bone Joint Surg Am 95(15):e104. https://doi.org/10.2106/JBJS.K.01516 CrossRefPubMed

33.

Levy JC, Blum S (2012) Postoperative acromion base fracture resulting in subsequent instability of reverse shoulder replacement. J Shoulder Elb Surg 21(4):e14–e18. https://doi.org/10.1016/j.jse.2011.09.018 CrossRef

34.

Mayne IP, Bell SN, Wright W, Coghlan JA (2016) Acromial and scapular spine fractures after reverse total shoulder arthroplasty. Should Elb 8(2):90–100. https://doi.org/10.1177/1758573216628783 CrossRef

35.

Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

36.

Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elb Surg 16(6):717–721. https://doi.org/10.1016/j.jse.2007.02.123 CrossRef

37.

Rouleau DM, Gaudelli C (2013) Successful treatment of fractures of the base of the acromion after reverse shoulder arthroplasty: case report and review of the literature. Int J Shoulder Surg 7(4):149–152. https://doi.org/10.4103/0973-6042.123531 CrossRefPubMedPubMedCentral

Title: Anatomical reconstruction to treat acromion fractures following reverse shoulder arthroplasty
Authors: Florian Hess
Ralph Zettl
Daniel Smolen
Christoph Knoth
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3710-0

At a glance: The STEP trials

Springer Medicine

Anatomical reconstruction to treat acromion fractures following reverse shoulder arthroplasty

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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