Top

International Orthopaedics

Published in:

01-07-2020 | Original Paper

The initial treatment of complex proximal humerus fracture affects the outcome of revision with reverse shoulder arthroplasty

Authors: Philippe Valenti, Frantzeska Zampeli, Grégoire Ciais, Jean Kany, Denis Katz

Published in: International Orthopaedics | Issue 7/2020

Abstract

Purpose

The purpose of the study is to report the results of reverse shoulder arthroplasty (RSA) after three types of initial treatment performed for complex proximal humeral fracture (PHF): conservative, reduction and internal fixation (RIF), or hemiarthroplasty.

Methods

This is a retrospective study of 63 patients separated into three groups with a minimum follow-up of two years. Group I included 25 patients with an initial conservative fracture treatment, group II included 25 patients treated by RIF, and group III included 13 patients initially treated by hemiarthroplasty. Patients were assessed using the absolute Constant-Murley score, functional parameters, complications rate, and radiological follow-up.

Results

One patient died and five were lost to follow-up. All functional outcomes improved significantly post-operatively for the three groups (p < 0.005). The mean Constant-Murley score increased from 13.7 to 54.1 (group I); 16.6 to 48.5 (group II); and 22.6 to 48.2 (group III) (p < 0.001). The gain of Constant-Murley and SST scores was better for group I (p = 0.049 and 0.028, respectively), while post-operative pain was better in group III (p = 0.033). The complication rate was 38% in group III, 30% in group II, and 14.3% in group I.

Conclusions

Reverse shoulder arthroplasty represents a good surgical option in complex proximal humeral fracture sequelae. Whatever the initial treatment, function and motion of the shoulder are improved. The final result is better if the initial treatment was conservative. The group initially treated with hemiarthroplasty had the most complications.

Court-Brown CM, McQueen MM (2008) Nonunions of the proximal humerus: their prevalence and functional outcome. J Trauma 64:1517–1521. https://doi.org/10.1097/ta.0b013e3181469840 CrossRefPubMed

Galatz LM, Iannotti JP (2000) Management of surgical neck nonunions. Orthop Clin North Am 31:51–61CrossRef

Siegel JA, Dines DM (2000) Proximal humerus malunions. Orthop Clin Noth Am 31:35–50. https://doi.org/10.1016/s0030-5898(05)70126-7 CrossRef

Dines DM, Warren RF, Altchek DW, Moeckel B (1993) Posttraumatic changes of the proximal humerus: malunion, nonunion, and osteonecrosis. Treatment with modular hemiarthroplasty or total shoulder arthroplasty. J Shoulder Elbow Surg 2:11–21. https://doi.org/10.1016/s1058-2746(09)80132-8 CrossRefPubMed

Kilic M, Berth A, Blatter G, Fuhrmann U, Gebhardt K, Rott O et al (2010) Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral head. Acta Orthop Traumatol Turc 44:417–425. https://doi.org/10.3944/aott.2010.2272 CrossRefPubMed

Nayak NK, Schickendantz MS, Regan WD, Hawkins RJ (1995) Operative treatment of nonunion of surgical neck fractures of the humerus. Clin Orthop Rel Res 313:200–205. https://doi.org/10.1007/s00402-013-1798-2 CrossRef

Simovitch RW, Helmy N, Zumstein MA, Gerber C (2007) Impact of fatty infiltration of the teres minor muscle on the outcome of reverse total shoulder arthroplasty. J Bone Joint Surg Am 89:934–939. https://doi.org/10.2106/jbjs.f.01075 CrossRefPubMed

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

Levy J, Frankle M, Mighell M, Pupello D (2007) The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am 89:292–300. https://doi.org/10.2106/jbjs.e.01310 CrossRefPubMed

10.

. 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 SurgAm 89:1476–1485. https://doi.org/10.2106/jbjs.f.00666

11.

Ernstbrunner L, Rahm S, Suter A, Imam MA, Catanzaro S, Grubhofer F (2020) Gerber C (2019) Salvage reverse total shoulder arthroplasty for failed operative treatment of proximal humeral fractures in patients younger than 60 years: long-term results. J Shoulder Elbow Surg 29(3):561–570. https://doi.org/10.1016/j.jse.2019.07.040 CrossRefPubMed

12.

García-Fernández C, Lopiz Y, Rizo B, Serrano-Mateo L, Alcobía-Díaz B, Rodríguez-González A, Marco F (2018) Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures. Injury 49(Suppl 2):S22–S26. https://doi.org/10.1016/j.injury.2018.06.042 CrossRefPubMed

13.

. Mechlenburg I, Rasmussen S, Unbehaun D, Amundsen A, Rasmussen JV (2020) Patients undergoing shoulder arthroplasty for failed nonoperative treatment of proximal humerus fracture have low implant survival and low patient-reported outcomes: 837 cases from the Danish Shoulder Arthroplasty Registry. Acta Orthop [Online ahead of print].DOI: https://doi.org/10.1080/17453674.2020.1730660

14.

Pastor MF, Kieckbusch M, Kaufmann M, Ettinger M, Wellmann M, Smith T (2019) Reverse shoulder arthroplasty for fracture sequelae: clinical outcome and prognostic factors. J Orthop Sci 24(2):237–242. https://doi.org/10.1016/j.jos.2018.09.016 CrossRefPubMed

15.

. Neyton L, Garaud P, Boileau P. Results of reverse shoulder arthroplasty in proximal humerus fracture sequelae. In: Walch G, Boileau P, Mole D, et al, editors. Reverse shoulder arthroplasty, clinical results, complications, revision. Montpellier (France) : Sauramps Medical;2006.p.81–101

16.

Boileau P, Chuinard C, Le Huec JC, Walch G, Trojani C (2006) Proximal humerus fracture sequelae. Impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res 442:121–130. https://doi.org/10.1097/01.blo.0000195679.87258.6e CrossRefPubMed

17.

Mansat P, Guity MR, Bellumore Y, Mansat M (2004) Shoulder arthroplasty for late sequelae of proximal humeral fractures. J Shoulder Elbow Surg 13:305–312. https://doi.org/10.1016/j.jse.2004.01.020 CrossRefPubMed

18.

Matsoukis J, Tabib W, Guiffault P, Mandelbaum A, Walch G, Némoz C, Cortés ZE, Edwards TB (2006) Primary unconstrained shoulder arthroplasty in patients with a fixed anterior glenohumeral dislocation. J Bone Joint Surg Am 88A:547–552. https://doi.org/10.2106/jbjs.e.00368 CrossRef

19.

Walch G, Badet R, Nove-Josserand L, Levigne C (1996) Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elbow Surg 5:161–168CrossRef

20.

. Raiss P, Neyton L, Walch G. Book currents concepts in shoulder arthroplasty 2013. Paris shoulder course. p155-159.

21.

Willis M, Min W, Brooks JP, Walker M, Pupello D, Frankle M (2012) Proximal humeral malunion treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg 21:507–513. https://doi.org/10.1016/j.jse.2011.01.042 CrossRefPubMed

22.

Martinez A, Bejarano C, Carbonel I, Iglesias D, Gil-Albarova J, Herrera A (2012) The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty. Injury, Int. J. Care Injured 43(S2):S3–S6. https://doi.org/10.1016/s0020-1383(13)70172-4 CrossRef

23.

Levy JC, Virani N, Pupello D, Frankle M (2007) Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br 89:189–195. https://doi.org/10.1302/0301-620x.89b2.18161 CrossRefPubMed

24.

Martin T, Iannotti J (2008) Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humeral fractures. Orthop Clin N Am 39:451–457. https://doi.org/10.1016/j.ocl.2008.06.006 CrossRef

25.

Lollino N, Paladini P, Campi F, Porcellini G (2011) Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus treated initially by internal fixation or hemiarthroplasty. Musculoskelet Surg 95(Suppl 1):S59–S63. https://doi.org/10.1007/s12306-009-0006-6 CrossRefPubMed

Title: The initial treatment of complex proximal humerus fracture affects the outcome of revision with reverse shoulder arthroplasty
Authors: Philippe Valenti
Frantzeska Zampeli
Grégoire Ciais
Jean Kany
Denis Katz
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04612-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The initial treatment of complex proximal humerus fracture affects the outcome of revision with reverse shoulder arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2020

The effects of length of femoral stem on aseptic loosening following cemented distal femoral endoprosthetic replacement in tumour surgery

Prospective pilot study to identify psychological factors influencing peri-operative pain in total knee arthroplasty (TKA)

Randomized controlled trial of chlorhexidine wash versus benzoyl peroxide soap for home surgical preparation: neither is effective in removing Cutibacterium from the skin of shoulder arthroplasty patients

Comment on the article “Comparison of posterior ring fixation with combined anterior and posterior ring fixation for the treatment of lateral compression type 2 pelvic fractures”

Effect of patient-specific instrument on lowering threshold for junior physicians to perform total hip arthroplasty on developmental dysplasia of the hip patients

Internal fixation and revision arthroplasty for interprosthetic femoral fractures: a case series of fifty patients