The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty

Treatment of fracture sequelae of the proximal humerus: comparison of hemiarthroplasty and reverse total shoulder arthroplasty

“…There are four principal investigations conducted to assess the outcomes of treatment of FS with RSA [5,20,21,32]. The results of the present investigation show higher improvement in Constant pain score, but similar improvements in total Constant score and Constant strength compared to other studies [20,21]. Boileau et al reported a higher improvement in total Constant score (46 points) compared to the present investigation [5].…”

“…In general, the improvements in Constant total and specific scores in the present sample were lower and complications requiring revision arthroplasty higher than previous studies [1-3, 10, 23, 25]. There are four principal investigations conducted to assess the outcomes of treatment of FS with RSA [5,20,21,32]. The results of the present investigation show higher improvement in Constant pain score, but similar improvements in total Constant score and Constant strength compared to other studies [20,21].…”

“…Anatomic arthroplasty (either hemiarthroplasty (HA) or total shoulder arthroplasty) for FS has demonstrated suboptimal and unpredictable results [1,9,10,12,17,25]. Some authors have reported good outcomes in reverse shoulder arthroplasty (RSA) for FS [20,21,32], and it has been suggested that RSA would be more appropriate than anatomic prostheses in FS, especially if varus deformity, tuberosities malunion or fatty infiltration of the rotator cuff [3,4,23]. There are several studies comparing anatomic and RSA for the treatment of acute PHF [6,8,13,24].…”

High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty

“…Reviewing the existing literature shows a high prevalence of periprosthetic infection in patients requiring secondary arthroplasty for failed fracture fixation [3,23,11,17]. Boileau et al and Wall et al showed in study groups of 5 and 33 patients, respectively, that patients with posttraumatic arthritis had a higher infection rate compared to patients with primary rotator cuff arthropathy when undergoing the same operative procedure [3,23].…”

“…They found a high infection rate of Patients with two or more positive probes or with one positive probe and an infection positive histo-pathological finding were rated as infected WBC white blood cell count, CRP C-reactive protein 11.4%, where 2 of the 55 patients had a history of shoulder infection [11]. Martinez et al reported, in 18 patients treated with a reverse prosthesis for proximal humeral non-unions, an infection rate of around 11% [17]. Therefore, our results show a demonstrable rate of low-grade infections, based on positive cultures in 4 of 28 (11%) patients with pre-existing fracture fixation devices.…”