Surgical treatment of fracture sequelae of the proximal humerus according to a pathology-based modification of the Boileau classification results in improved clinical outcome after shoulder arthroplasty

Abstract

Background Fracture sequelae of the proximal humerus were classified by Boileau into four types. Since there are pathomorphological differences and specific characteristics within the four types, we have developed a subclassification. For elderly patients, shoulder arthroplasty is mostly recommended. Based on the available literature and clinical trial results, a subclassification could be created that suggests a specific therapy for each subgroup. The aim of this study was to evaluate the endoprosthetic therapy according to the proposed subclassification and to provide an overview of the clinical and radiological results after endoprosthetic treatment of proximal humerus fracture sequelae. Methods Patients with fracture sequelae of the proximal humerus who underwent arthroplasty according to the suggestion of the subclassification were included. Minimum time to follow-up was twelve months. General condition and several specific shoulder scores as the Constant–Murley Score (CS) were recorded at the follow-up examination. Complication and revision rates were analyzed. Results In total, 59 patients (72.6 ± 10.0 years, 47 females, 12 males) were included. Mean follow-up time was 31.3 ± 17.0 months. Reverse shoulder arthroplasty was performed in 49 patients and anatomic shoulder arthroplasty was performed in ten patients. The CS increased by 47.3 points from preoperative (15.0) to postoperative (62.3). Good or very good clinical results were seen in 61% of the patients. Complications were observed in twelve (20%) patients and revision surgery was performed in nine (15%) patients. Conclusion Due to of the variety of fracture sequelae of the proximal humerus, a modification of the Boileau classification seems necessary. This study shows that endoprosthetic treatment for fracture sequelae can significantly improve the shoulder function in elderly patients. Good clinical results can be achieved with a comparatively low revision rate following the treatment suggestions of the proposed subclassification of the Boileau classification. Level of evidence IV Case series.

Reverse Shoulder Prosthesis for Proximal Humeral Fractures: Primary Treatment vs. Salvage Procedure

“…By evaluating HA and TSA surgeries instead, the need to perform anatomic reconstruction of the tuberosities is well established: different studies have correlated the clinical outcomes and survival rate of these surgical treatments with the need to have good tuberosities and so a competent rotator cuff [ 9 , 10 ]. Among this evolving spectrum of treatment options, RTSA has emerged as a viable solution, both as a primary intervention for PHF and in cases of failed other treatments [ 5 , 11 ] ( Figure 1 ). The biomechanical properties of RTSA [ 12 , 13 ], characterized by its semi-constrained design and decreased dependence on the union of tuberosities and rotator cuff function, theoretically provide an advantage over traditional nonconstrained arthroplasty in instances of unsuccessful internal fixation [ 14 ].…”