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Reverse shoulder arthroplasty for type 1 sequelae of a fracture of the proximal humerus.

Abstract Aims The aim of this study was to analyze the results of reverse shoulder arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff deficiency or severe stiffness of the shoulder. Patients and Methods A total of 38 patients were included: 28 women and ten men. Their mean age at the time of arthroplasty was 73 years (54 to 91). Before the RSA, 18 patients had been treated with open reduction and internal fixation following a fracture. A total of 22 patients had a rotator cuff tear and 11 had severe stiffness of the shoulder with < 0° of external rotation. The mean follow-up was 4.3 years (1.5 to 10). The Constant score and the range of movement of the shoulder were recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as well as CT or arthro-CT scans; radiographs were also performed at final follow-up. Results The mean Constant score improved from 25 points (5 to 47) preoperatively to 57 points (15 to 81) postoperatively. The mean forward elevation of the shoulder increased from 73° (10° to 130°) preoperatively to 117° (15° to 170°) postoperatively. Previous surgery did not influence the outcome. Patients with rotator cuff tears had lower Constant scores than patients without (p = 0.037). Those with preoperative stiffness of the shoulder had lower postoperative external rotation compared with patients without stiffness (p = 0.046). There was no radiographic evidence of loosening. Three complications occurred, leading to revision surgery in two patients. In all, 17 patients rated their result as very good (45%), another 17 as good (45%), two as satisfactory (5%), and two as unsatisfactory (5%). Discussion RSA is an effective form of treatment for patients with type 1 sequelae of a fracture of the proximal humerus associated with rotator cuff deficiency or stiffness of the shoulder, with high rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an adverse effect on the clinical outcome. Cite this article: Bone Joint J 2018;100-B:318-23.
PMID
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Authors

Mayor MeshTerms
Keywords

Fracture sequelae

Post-traumatic

Reverse arthroplasty

Reverse shoulder arthroplasty

Shoulder arthroplasty

Shoulder implant

Shoulder replacement

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589495
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20180402
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - Reverse shoulder arthroplasty for type 1 sequelae of a fracture of the proximal
      humerus.
PG  - 318-323
LID - 10.1302/0301-620X.100B3.BJJ-2017-0947.R1 [doi]
AB  - Aims The aim of this study was to analyze the results of reverse shoulder
      arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal
      humerus in association with rotator cuff deficiency or severe stiffness of the
      shoulder. Patients and Methods A total of 38 patients were included: 28 women and
      ten men. Their mean age at the time of arthroplasty was 73 years (54 to 91).
      Before the RSA, 18 patients had been treated with open reduction and internal
      fixation following a fracture. A total of 22 patients had a rotator cuff tear and
      11 had severe stiffness of the shoulder with &lt; 0 degrees of external rotation.
      The mean follow-up was 4.3 years (1.5 to 10). The Constant score and the range of
      movement of the shoulder were recorded preoperatively and at final follow-up.
      Preoperatively, radiographs in two planes were performed, as well as CT or
      arthro-CT scans; radiographs were also performed at final follow-up. Results The 
      mean Constant score improved from 25 points (5 to 47) preoperatively to 57 points
      (15 to 81) postoperatively. The mean forward elevation of the shoulder increased 
      from 73 degrees (10 degrees to 130 degrees ) preoperatively to 117 degrees (15
      degrees to 170 degrees ) postoperatively. Previous surgery did not influence the 
      outcome. Patients with rotator cuff tears had lower Constant scores than patients
      without (p = 0.037). Those with preoperative stiffness of the shoulder had lower 
      postoperative external rotation compared with patients without stiffness (p =
      0.046). There was no radiographic evidence of loosening. Three complications
      occurred, leading to revision surgery in two patients. In all, 17 patients rated 
      their result as very good (45%), another 17 as good (45%), two as satisfactory
      (5%), and two as unsatisfactory (5%). Discussion RSA is an effective form of
      treatment for patients with type 1 sequelae of a fracture of the proximal humerus
      associated with rotator cuff deficiency or stiffness of the shoulder, with high
      rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an
      adverse effect on the clinical outcome. Cite this article: Bone Joint J
      2018;100-B:318-23.
FAU - Raiss, P
AU  - Raiss P
AD  - OCM (Orthopadische Chirurgie Munchen) Clinic, Steinerstrasse 6, 81369 Munchen,
      Germany.
FAU - Alami, G
AU  - Alami G
AD  - Chirurgie Orthopedique, Hopital St-Jerome, 290 Rue de Montigny, Saint-Jerome,
      St-Jerome, Quebec J7Z-5T3, Canada.
FAU - Bruckner, T
AU  - Bruckner T
AD  - University of Heidelberg, Institute of Medical Biometry and Informatics, Im
      Neuenheimer Feld 305, 69120 Heidelberg, Germany.
FAU - Magosch, P
AU  - Magosch P
AD  - ATOS Clinic Heidelberg, Bismarckstrasse 9-15, 69115 Heidelberg, Germany.
FAU - Habermeyer, P
AU  - Habermeyer P
AD  - ATOS Clinic Heidelberg, Bismarckstrasse 9-15, 69115 Heidelberg, Germany.
FAU - Boileau, P
AU  - Boileau P
AD  - Hopital Pasteur 2, 30, Avenue de la Voie Romaine, 06001 Nice, France.
FAU - Walch, G
AU  - Walch G
AD  - Centre Orthopedique Santy, 24, Avenue Paul Santy, 69008 Lyon, France.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Bone Joint J
JT  - The bone &amp; joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthroplasty, Replacement, Shoulder/*methods
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Humeral Fractures/diagnostic imaging/*surgery
MH  - Male
MH  - Middle Aged
MH  - Open Fracture Reduction/*methods
MH  - Range of Motion, Articular
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Fracture sequelae
OT  - Post-traumatic
OT  - Reverse arthroplasty
OT  - Reverse shoulder arthroplasty
OT  - Shoulder arthroplasty
OT  - Shoulder implant
OT  - Shoulder replacement
EDAT- 2018/03/29 06:00
MHDA- 2018/04/03 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0947.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):318-323. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0947.R1.