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Archives of Orthopaedic and Trauma Surgery

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01-12-2019 | Periprosthetic Fracture | Orthopaedic Surgery

Non-fracture stem vs fracture stem of reverse total shoulder arthroplasty in complex proximal humeral fracture of asian elderly

Authors: Jae-Jung Jeong, Chae-Gwan Kong, Sang-Eun Park, Jong-Hun Ji, Won-Ha Whang, Bong-Seok Choi

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2019

Abstract

Purpose

Fracture stem of the reverse total shoulder arthroplasty (RTSA) was designed for better tuberosity bone healing for the proximal bone defect of complex proximal humeral fractures (PHF). Our purpose was to compare the clinical and radiological outcomes of patients using fracture stem vs non-fracture (conventional) stem of RTSA in complex PHF of elderly patients.

Methods

Between 2008 March and 2017 June, 48 patients who had undergone an RTSA with non-fracture or fracture stem for complex PHF with a minimum 18 months of follow-up were evaluated. Finally, total 45 patients with a mean age of 80 ± 7 years (65–92 years) were enrolled because three patients were excluded due to age related mortality. We divided them into two groups: 25 patients using non-fracture stem (non-fracture stem group) in the early period of this study, and consecutive 20 patients using fracture stem (fracture stem group) in the later period. Between two groups, we compared clinical and radiologic outcomes such as tuberosity failure, heterotopic ossification (HO), dislocation, acromion fracture, notching, loosening and periprosthetic fracture.

Results

In all patients, clinical outcomes were improved significantly and tuberosity failure was found in 62% (28/45). Between two groups, there were no statistically significant differences on clinical outcomes and radiologic outcomes except UCLA score. As complications, two humeral stem revision was performed due to tuberosity failure related HO and stem loosening with subsequent periprosthetic fracture in non-fracture stem group.

Conclusions

Compared to non-fracture stem, fracture stem usage of RTSA in complex PHF of elderly patients has no significant different impact on clinical and radiological outcomes. However, tuberosity failure related secondary HO of non-fracture stem might be responsible for stem loosening and periprosthetic fracture in the RTSA for complex PHF of elderly patients.

Level of evidence

Level IV, case series study.

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Title: Non-fracture stem vs fracture stem of reverse total shoulder arthroplasty in complex proximal humeral fracture of asian elderly
Authors: Jae-Jung Jeong
Chae-Gwan Kong
Sang-Eun Park
Jong-Hun Ji
Won-Ha Whang
Bong-Seok Choi
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keyword: Periprosthetic Fracture
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03190-y

At a glance: The STEP trials

Springer Medicine

Non-fracture stem vs fracture stem of reverse total shoulder arthroplasty in complex proximal humeral fracture of asian elderly

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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