Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

“…We tried to reattach the greater tuberosity and can confirm that the results with reattached and healed greater tuberosities are better than those with resected or secondarily displaced greater tuberosities, 8,15,27,31,36 so a major effort to reattach the greater tuberosity seems clearly justified. Compared with hemiarthroplasty, in which nonunion or displacement of the greater tuberosity has been reported to occur at a rate of 20% to 50%, 12 tuberosity nonunion or displacement of the greater tuberosity occurred in only 9%.…”

Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study

“…2 RSA has been proposed as an alternative treatment for these acute complex fractures 7,11 on the basis of the potential advantage that the functional results are less dependent on healing of the tuberosities and integrity of the rotator cuff, but this is still under assessment. Although recent studies reported satisfactory results with RSA, 15,20,23,35 they also reported a relevant number of complications. 6,9 Moreover, there were few studies comparing the 2 types of prostheses for these acute fractures.…”

“…By contrast, other studies reported rates between 25% and 73%. In these last studies, 7,9,12,15 most of the patients underwent RSA with the Delta III prosthesis. The cause of the notch appears to be multifactorial.…”

Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique

“…5,7,8,16,31,36 When RSA is performed for similar fractures, anatomic tuberosity healing has been considered less important, and there are several published series in which the tuberosities have been excised. 9,18 However, recent studies suggest that greater tuberosity healing provides improvements in active forward elevation, 4 external rotation, 14 and external rotation strength 21 and may limit the chances of early prosthetic dislocation. 21 With a common goal of secure tuberosity fixation, multiple suture and bone grafting techniques together with updated implant designs have been developed in an attempt to increase the healing rates of the tuberosities.…”

“…5,7,8,16,31,36 However, only recently has the importance of tuberosity healing after RSA been recognized. Studies have shown that healing of the greater tuberosity results in improvements in active forward elevation, 4 external rotation, 4,14 and external rotation strength. 21 As RSA gains popularity in fracture management, more emphasis on tuberosity repair for restoration of rotational shoulder function may be warranted.…”