Shoulder Arthroplasty for Fracture: Does a Fracture-specific Stem Make a Difference?

Abstract

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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

“…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. 1,13,[19][20][21]24,25,27 Reported tuberosity healing rates after RSA for fracture range from 47% to 100% (Table II). 6,8,10,14,15,21,28,36 Several of the surgical techniques and implant characteristics used to enhance tuberosity healing after hemiarthroplasty have been applied to RSA.…”

“…1,13,[19][20][21]24,25,27 The suture construct chosen for tuberosity repair is critical to prevent displacement and to maintain position of the fracture fragments. 1,13 Implant design has been adapted to accommodate suture fixation to the stem, fins to resist rotational stress, and larger surface areas for tuberosity healing with bone-graft voids and ongrowth/ingrowth surfaces.…”

“…1,13 Implant design has been adapted to accommodate suture fixation to the stem, fins to resist rotational stress, and larger surface areas for tuberosity healing with bone-graft voids and ongrowth/ingrowth surfaces. 19,24,25 Structural bone grafts have also been used to enlarge the area for tuberosity repair and healing potential. 21 Last, partially cemented techniques for the humeral stem have been proposed to shield the intact proximal humerus and tuberosities from cement-induced thermal necrosis that may occur at the junction of the cement mantle and the tuberosities.…”

Surgical Management of Proximal Humerus Fractures by Philos Locking Plate

“…[14][15][16][17][18][19] The average clinical result obtained in our study, with a mean Constant-Murley score of 76 points is satisfactory. Correct anatomical reduction with proper plate positioning led to a significantly better result with Constant-Murley score of 81.…”

Protesi di spalla in acuto

“…Una volta impiantata la componente omerale si procede alla ricostruzione periprotesica delle tuberosità. Sono state descritte svariate tecniche di sutura per garantire la massima stabilità dei frammenti e anche il design degli impianti si è evoluto per cercare di ottimizzare e facilitare questa fase critica dell'intervento [12,13]. In realtà, il risultato finale è in larga pare influenzato dal pattern di frattura: la comminuzione delle tuberosità, in particolare del trochite, è infatti una condizione che rende praticamente impossibile una ricostruzione anatomica.…”