Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up

Gunst, Stanislas; Louboutin, Lucie; Swan, John; Lustig, Sébastien; Servien, Elvire; Nové-Josserand, Laurent

doi:10.1007/s00264-020-04928-9

Cited by 17 publications

(18 citation statements)

References 25 publications

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“…An overall tuberosity healing rate of 68% was recently described in a meta-analysis [36]. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival [37][38][39][40]. Biomechanically, a considerable drop in the joint reaction forces on the shoulder occurs with tuberosity non-union [41].…”

Section: Importance Of Tuberosity Healing On Functionmentioning

confidence: 99%

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Borbas

Grubhofer

et al. 2021

JCM

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Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.

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Section: Importance Of Tuberosity Healing On Functionmentioning

confidence: 99%

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Borbas

Grubhofer

et al. 2021

JCM

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“…Some recent publications have reported an improvement in functional results, especially in terms of forward elevation and external rotation if we achieve an anatomical union of the greater tuberosity as well as to an influence on the stability of the prosthesis. 16 – 24 Others have reported that the tuberosity position has no influence on the functional outcomes. 10 , 25 – 28 …”

Section: Introductionmentioning

confidence: 99%

“…Few studies use the CT scan to confirm this parameter. 17 , 23 , 25 To date, no study has analyzed the reliability of this assessment.…”

Section: Introductionmentioning

confidence: 99%

Is the Position and Union of the Tuberosities Assessable by Means of the Simple Radiograph After Reverse Shoulder Arthroplasty for Complex Proximal Humerus Fractures?

Masnou

Macarrilla

Solé

et al. 2023

Journal of Shoulder and Elbow Arthroplasty

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Background The assessment of tuberosity position and union in reverse shoulder arthroplasty (RSA) for complex proximal humerus fractures (PHF) has been carried out by means of routine simple radiographs. To evaluate the interobserver agreement and intraobserver reproducibility of the simple radiograph in comparison to the CT scan. Methods The position and consolidation of the tuberosities in 2 radiographic projections and in a CT scan of 32 consecutive patients operated on a RSA for PHF was assessed by 5 observers. Interobserver agreement and intraobserver reproducibility in both imaging tests were also assessed. Results The interobserver agreement for the greater tuberosity position was 0.52 in the simple radiograph and 0.45 in the CT scan. For the greater tuberosity union, agreement was moderate in the simple radiograph (0.52), but fair in the CT scan (0.35). For the lesser tuberosity position and union, the agreement was fair in the radiograph and poor in the CT scan. Conclusion Only moderate agreement was observed in the assessment of the position and union of the tuberosities in the RSA for PHF in the simple radiograph and no improvement in it was seen for the 2D CT scan.

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“… 15 , 29 , 41 , 43 The most frequent complications are implant instability (1.5%-31%) and reabsorption, nonunion, or malunion of the tuberosities (16%-60%). 6 , 14 , 22 , 24 , 25 , 35 In addition, nonunion of the tuberosities can cause subsequent loss of external and internal rotation and subacromial impingement. 7 , 25 , 36 , 39 …”

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confidence: 99%

Surgical learning curve in reverse shoulder arthroplasty for proximal humerus fractures

Blaas¹,

Yuan²,

Lameijer³

et al. 2021

JSES International

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Background Fracture reverse shoulder arthroplasty (fRSA) in geriatric, complex dislocated proximal humerus fractures is becoming the standard treatment next to conservative treatment. fRSA is a multifaceted, reasonably challenging procedure of which functional outcomes and complication rates are likely to depend on the experience of the surgeon. The goal of this study was to determine whether there is a learning curve for fRSA. Methods All patients with a dislocated multipart proximal humerus fracture that were treated with an fRSA between 2013 and 2019 in a specialized institution were included. The functional outcomes (Constant Shoulder Score, Oxford Shoulder Score, and range of motion), complications, and operation time of fRSA were assessed with linear regression plots and cumulative summation analysis to establish whether a learning curve was present. Results In this cohort study, 50 patients were included. They had a mean age of 77.1 years and were treated with an fRSA by one trauma surgeon. Learning curves were distinguished for functional outcomes, complications, and operation time based on learning targets for daily activity and the mean complications and operation time. Results indicated that an optimal treatment is achieved after performing 20 fRSAs. Conclusion The results show that functional outcomes of PHFs treated with an fRSA improve with surgical experience. Also, outcomes are getting less variable after about 20 procedures. Surgeons starting this procedure should be aware of the learning curve and, therefore, should consider guidance from an experienced surgeon to swiftly optimize functional outcomes and prevent unnecessary complications.

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Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up

Cited by 17 publications

References 25 publications

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Is the Position and Union of the Tuberosities Assessable by Means of the Simple Radiograph After Reverse Shoulder Arthroplasty for Complex Proximal Humerus Fractures?

Surgical learning curve in reverse shoulder arthroplasty for proximal humerus fractures

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