Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes

Torrens, Carlos; Alentorn-Geli, Eduard; Mingo, Felipe; Gamba, Carlo; Santana, Fernando

doi:10.1177/2309499018760132

Cited by 41 publications

(63 citation statements)

References 23 publications

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“…As for the second objective of the study, tuberosity healing occurred in 76.3% of the patients. 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.…”

Section: Discussionsupporting

confidence: 92%

“…In a prospective study evaluating patients with complex PHF undergoing RSP, Bufquin et al 15 concluded that tuberosity non-healing does not necessarily lead to a poor outcome. Torrens et al 22 stated that clinical results are superimposable, not depending on tuberosity healing. Reverse shoulder prostheses are based on the classical principles of the prosthesis developed by Grammont: a) a semi-constrictive fixed point (fulcrum) prosthesis enabling the deltoid to elevate the arm in a way that does not require rotator cuff action, and b) a lower, medialized center of rotation, which enables deltoid extension and thus decreases the force required for arm abduction.…”

Section: Discussionmentioning

confidence: 99%

“…Em estudo prospectivo realizado por Bufquin et al, 15 em que foram avaliados pacientes com FUPs complexas submetidos a PRO, foi concluído que a não consolidação dos tubérculos não implica necessariamente um mau resultado final. Torrens et al 22 afirmam que os resultados clínicos são sobreponíveis, não dependendo da consolidação dos tubérculos. As PROs se baseiam nos princípios clássicos da prótese desenvolvida por Grammont: a) uma prótese semiconstritiva com ponto de fixação (fulcro) fixo, a partir do qual o deltoide realiza elevação do braço sem necessidade de recurso dos manguitos rotadores, e b) centro de rotação medializado e mais baixo, o que permite alongar o deltoide e assim diminuir a força necessária para realizar abdução do braço.…”

Section: Discussionunclassified

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

Barros

Figueiredo

Marqués

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Comparar os resultados funcionais entre pacientes com fratura complexa do úmero proximal submetidos a artroplastia reversa com tubérculos consolidados e tubérculos não consolidados. O objetivo secundário foi determinar a taxa de consolidação dos tubérculos com este tipo de prótese. Métodos Estudo de tipo coorte, retrospectivo, com coleta prospectiva de dados. No total, 28 pacientes cumpriram os critérios de inclusão: idade superior a 65 anos, prótese reversa do ombro por fratura complexa do úmero proximal (3 ou 4 partes, segundo Neer), e tempo de seguimento mínimo de 24 meses. Aos seis meses, todos os pacientes foram avaliados radiograficamente quanto à consolidação dos tubérculos e divididos em dois grupos: grupo com tubérculos consolidados e grupo com tubérculos não consolidados. A avaliação funcional realizou-se segundo o sistema de pontuação de Constant, da amplitude de movimento ativo, e da Escala Visual Analógica (EVA) à data da última consulta. Registaram-se todas as complicações. Resultados A consolidação dos tubérculos ocorreu em 21 pacientes (76,3%). Verificou-se diferenças estatisticamente significativas no sistema de pontuação de Constant (p < 0.001), elevação anterior (p = 0.020), rotação interna (p = 0.001) e externa (p = 0.003), quando se comparou o grupo dos tubérculos consolidados com o grupo dos tubérculos não consolidados. Não houve diferenças significativas na EVA entre os 2 grupos. Conclusão A consolidação dos tubérculos traduz uma melhoria dos resultados funcionais em pacientes submetidos a artroplastia reversa do ombro como tratamento de fraturas complexas do úmero proximal em idosos.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

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

Barros

Figueiredo

Marqués

et al. 2020

Rev Bras Ortop (Sao Paulo)

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“…After screening, 277 documents were excluded, thus including 46 for full-text review. Of these 46 references, 25 were excluded and 21 studies were included in the final evidence tables [18][19][20][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. Table 1 shows the level of evidence of the selected studies.…”

Section: Resultsmentioning

confidence: 99%

Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review

Torre

García

Smith

et al. 2019

JCM

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The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant–Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.

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“…The incidence and severity of notching were high with first-generation RTSA, but the scapular notch rate in fracture patients tended to be lower than that reported for cuff-deficient patients. 37 The potential progression of scapular notching is worrisome, although the long-term effects of this finding have yet to be elucidated. Severe erosions of the scapular neck causing glenoid component loosening are infrequent, particularly with newer RTSA designs.…”

Section: Hemiarthroplasty Vs Reverse Total Shouldementioning

confidence: 99%

Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont

Grassi¹,

Alberio²,

Ratti³

et al. 2020

Orthop Rev (Pavia)

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Shoulder replacement is indicated for the surgical treatment of proximal humeral fractures in elderly patients, when severe comminution and osteoporosis jeopardize the chances of success of any fixation technique. Two different implants are available for this purpose: anatomical hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA). HA for fractures was popularized by Charles Neer in the ‘50s and for several decades remained the only reliable implant for these injuries. However, many authors reported inconsistent results with HA as a consequence of the high rate of tuberosity and rotator cuff failure. In 1987, Paul Grammont designed the first successful RTSA, which was the end result of a long thought process on functional surgery of the shoulder. This implant was initially used to treat cuff tear arthropathy and shoulder pseudoparalysis, but indications have gradually expanded with time. Since RTSA does not rely on a functional cuff for shoulder elevation, it was felt that results in fractures could be improved by this prosthesis. In this study, the salient features of these implants are described to understand the rationale behind both approaches and highlight their pros and cons. Several clinical studies comparing HA vs RTSA for proximal humeral fractures have been published during the last two decades. A literature review is carried out to analyze and compare outcomes of both implants, analyzing clinical results, radiographic findings and complications. The final goal is to provide an overview of the different factors to consider for making a choice between these two prostheses.

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Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes

Cited by 41 publications

References 23 publications

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

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

Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review

Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont

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