Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures

García-Fernández, Carlos; Lópiz, Yaiza; Rizo, Belén; Serrano-Mateo, Laura; Alcobía-Díaz, B.; Rodríguez-González, Alberto; Marco, Fernando

doi:10.1016/j.injury.2018.06.042

Cited by 26 publications

(20 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Proximal humeral fractures represent the third most common fracture type in the elderly population (1,2). The management of these injuries remains challenging due to demographic changes, as well as the simultaneous incidence of osteoporosis, and various other comorbidities (1). The spectrum of surgical treatment modalities include closed reduction and percutaneous pin xation (1), open reduction and internal…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Secondary Fracture Care: Mid-Term Outcomes in a Single-Centre Experience

Schwarz

Hohenberger

Sauerschnig

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium.The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).Methods This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: two years, minimum age: 60 years).The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05 and 95% confidence intervals).Results Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p = .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.Conclusions RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.Trial RegistrationNot applicable, level of evidence III.

show abstract

Section: Introductionmentioning

confidence: 99%

Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Secondary Fracture Care: Mid-Term Outcomes in a Single-Centre Experience

Schwarz

Hohenberger

Sauerschnig

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Proximal humeral fractures (PHFs) represent the third most common fracture type in the elderly population (1,2). Due to demographic changes, the simultaneous incidence of osteoporosis, and various other comorbidities, the management of these injuries remains challenging (1). The spectrum of surgical treatment modalities include closed reduction and percutaneous pin xation (1), open reduction and internal xation (ORIF) by locking or non-locking plates (3)(4)(5)(6)(7) and intramedullary nails (8,9).…”

Section: Introductionmentioning

confidence: 99%

“…Due to demographic changes, the simultaneous incidence of osteoporosis, and various other comorbidities, the management of these injuries remains challenging (1). The spectrum of surgical treatment modalities include closed reduction and percutaneous pin xation (1), open reduction and internal xation (ORIF) by locking or non-locking plates (3)(4)(5)(6)(7) and intramedullary nails (8,9). Further primary non-joint-preserving treatment options for PHFs include anatomical total shoulder arthroplasty (ASA) (10)(11)(12)(13), hemiarthroplasty (HA) (14), and reverse shoulder arthroplasty (RSA) (13,(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…Thus, indications have been extended to further pathologies, such as cuff tear arthropathy (26,27) , and proximal humeral fractures (PHFs) (17,28) or revision arthroplasty (29). Moreover, RSA is used as a salvage procedure in cases of symptomatic mal-or non-unions following (failed) primary osteosynthesis or HA of PHFs (1,13,29).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Salvage Fracture Care - Clinical and Radiological Outcome in Mid-term Follow-up in a Single-Center Experience

Schwarz

Hohenberger

Sauerschnig

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, including patients with poor bone quality, has significantly extended the surgical armamentarium.The aim of this study was to investigate the mid-term outcome following fracture RSA (FRSA) in acute or sequelae, as well as salvage procedures. It was hypothesized that revision FRSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).Methods This retrospective case-series study describes the radiological and clinical mid-term outcome in a standardized single-center and one-material Inlay design. Patients who underwent FRSA between 2008 and 2017 were matched (minimum follow-up: two years, minimum age at the time of operation: 60 years).The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, Quick DASH, and Subjective Shoulder Value. All adverse events and the radiological results and their clinical correlations were analyzed statistically (using α = 5% and 95% confidence intervals).Results Following FRSA, 68 patients were included (mean age: 72.5 years, mean FU: 46 months). Forty-two underwent primary RSA (PRSA), 26 revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).No statistically significant results were found in PRSA and SRSA in effect sizes by scores, whereby the failed osteosynthesis SRSA subgroup obtained significantly negative values in ROM subzones (flexion: p = .046, abduction: p = .037). Decreased tubercle healings in PRSA relative to SRSA were observed (p = .006). A missing bony healing of the tubercles was related to significant negative clinical outcome (all scores: p < .05, external rotation: p = .019). In SRSA, significant postoperative improvements could be stated (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.Conclusions RSA is an effective option in severe shoulder fracture management with predictable results as salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and a high patient satisfaction could be achieved.Trial RegistrationNot applicable, level of evidence III.

show abstract

Exposure of the brachial plexus in complex revisions to reverse total shoulder arthroplasty

Rojas

Familiari

Borade

et al. 2019

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Background Excision of extensive scar tissue (EEST) may be required in certain cases of revision reverse total shoulder arthroplasty (RTSA). Neurovascular structures are at a higher risk of iatrogenic direct injury in these cases. We describe a technique to expose and protect the musculocutaneous and axillary nerves in a series of revision RTSA cases that required EEST. Methods Between 2004 and 2013, 83 revision RTSA procedures were identified in our database. Of these, 18 cases (22%) who underwent concomitant nerve exploration for EEST preventing glenoid exposure, preventing reduction of the humeral component, or causing instability of the implanted RTSA, were included. All patients were observed for a minimum of two years or until reoperation. Patient-reported outcome scores (PROMs), range of motion (ROM), and complication rates were analyzed. Results Patients had significant pain relief and improvement in PROMs post-operatively. Two patients (11%) required another revision surgery because of infection (one patient with glenoid loosening; one patient with stem loosening). Two patients (11%) had instability successfully managed with closed reduction. Two patients (11%) had a clinically evident post-operative nerve injury. Both cases were neurapraxias (1 partial brachial plexopathy and 1 partial isolated axillary nerve injury) and experienced complete neurologic recovery at last follow-up. Conclusions Complete permanent nerve injuries resulting from direct surgical trauma during revision RTSA requiring EEST can be avoided using the technique presented here. Despite proper exposition of the nerves, partial temporary neurapraxic injuries may occur. Patients who underwent this procedure experienced significant improvements in shoulder pain and function with complication rates consistent to those previously reported in revision RTSA.

show abstract

Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures

Cited by 26 publications

References 29 publications

Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Secondary Fracture Care: Mid-Term Outcomes in a Single-Centre Experience

Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Secondary Fracture Care: Mid-Term Outcomes in a Single-Centre Experience

Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Salvage Fracture Care - Clinical and Radiological Outcome in Mid-term Follow-up in a Single-Center Experience

Exposure of the brachial plexus in complex revisions to reverse total shoulder arthroplasty

Contact Info

Product

Resources

About