Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities?

Abstract

Hypothesis: Reverse Shoulder Arthroplasty (RSA) may be indicated in displaced proximal humerus fractures in elderly patients. We hypothesized that tuberosity fixation and healing around the prosthesis would result in better outcomes and patient satisfaction. Methods: Thirty-eight acute displaced or dislocated 3-and 4-part fractures in elderly patients were treated with reattachment of the tuberosities around a RSA. The mean age at surgery was 80 ± 4 years (range, 70-88 years). A specific reverse fracture stem that incorporated a cancellous bone autograft (harvested from the fractured head) and a standardized suturing technique for tuberosity fixation were used in all operations. Patients were evaluated and radiographed with a minimum 2-year follow-up (mean 36 ± 8 months). Results: The tuberosity union rate was 84% (32 of 38). There were 4 tuberosity resorptions and 2 tuberosity migrations with nonunion, which were associated with significantly lower subjective results (Subjective Shoulder Value of 65% vs. 83%, P = .029) and lower active mobility in forward elevation (115°± 26°vs. 141°± 25°, P = .023) and external rotation (11°± 12°vs. 27°± 12°, P = .010). Among the 5 disappointed patients, 3 presented with tuberosity resorption and 2 with tuberosity migration and nonunion. Conclusions: Despite the advanced age of the patients, tuberosity reattachment and use of bone graft results in a high rate of tuberosity healing. Tuberosity reconstruction and healing in reverse shoulder arthroplasty for fractures improves active forward elevation, external rotation, and patient satisfaction.

Fracture-Specific and Conventional Stem Designs in Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures—A Retrospective, Observational Study

“…Our data supports those findings of Grubhofer et al [ 39 ] and Boileau et al [ 40 ] that patients with GT healing improve in external rotation, forward flexion, and subjective function.…”

“…This higher rate of anatomical tuberosity healing in group B could account for the better results on average in CS, ROM, and SSV because according to theoretical models, GT healing does improve stability through deltoid wrapping [ 41 ]. Tuberosity healing has been described in the literature with similar GT healing of 65–84% [ 21 , 39 , 40 , 42 , 43 ] comparable to a rate of 82% for both group A and B.…”

Consolidação dos tubérculos na artroplastia reversa do ombro após fratura proximal do úmero: Existe melhoria nos resultados funcionais?

“…We observed that increased patient mobility corresponded to CS improvement (79 versus 55). Boileau et al 28 summarize their study by stating that tuberosity healing not only improves FE and ER, but also the patients' quality of life.…”

“…This percentage is in line with more recent studies, 22,29,30 and it is superior to older works. Boileau et al 28 describe a higher healing rate, of 84%, arguing that tuberosity healing in fractures submitted to RSP is a reproducible procedure even in the elderly. In addition, new developed prostheses, designed specifically for fractures and presenting a window in the metaphyseal region, enable better tuberosity integration and healing.…”

Tuberkulafixierung bei inverser Frakturprothese

“…Ob die Tuberkula refixiert oder reseziert werden sollen, wird unterschiedlich beurteilt. Dabei wird über bessere Ergebnisse in der aktiven Außenrotation nach Refixation und Einheilung der Tuberkula in nahezu anatomischer Position am proximalen Schaft berichtet [2][3][4]. Auch die Häufigkeit von Luxationen wird bei refixierten Tuberkula reduziert [5].…”