Tuberosity malposition and migration: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus

Boileau, Pascal; Krishnan, Sumant G.; Tinsi, L.; Walch, Gilles; Coste, J.; Molé, Daniel

doi:10.1067/mse.2002.124527

Cited by 609 publications

(484 citation statements)

References 25 publications

Supporting

Mentioning

438

Contrasting

Unclassified

Order By: Relevance

“…For example, the functional status of the patient at the baseline and his/her associated neurological deficits could not be retrieved and this could be a bias that influenced the outcome. Reconstruction of the tuberosity is an important technical consideration in shoulder hemiarthroplasty [14]. These data were also not retrieved from the literature and the effect of this variable on the outcome could not be studied.…”

Section: Discussionmentioning

confidence: 98%

Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

deHaan¹,

deHartog²,

Schep³

et al. 2010

TOORTHJ

View full text Add to dashboard Cite

Abstract:The objective was to identify whether arthroplasty or conservative treatment is the best available treatment for three-and four-part proximal humeral fractures by analyzing the outcome measure of the Constant score. We conducted an electronic search. The systematic review included 33 studies encompassing 1096 patients with three-or four-part proximal humeral fractures that used the Constant score as outcome measure. The mean Constant score in the conservative group was 66.5 and in the arthroplasty group was 55.5. The difference could be attributed to selection bias, unreliable classification of the fractures and inter-observer differences in the assessment of the Constant score.

show abstract

Section: Discussionmentioning

confidence: 98%

Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

deHaan¹,

deHartog²,

Schep³

et al. 2010

TOORTHJ

View full text Add to dashboard Cite

show abstract

“…In a study by Tanner and Cofield [22], post-operative displacement of the greater tuberosity was thought to be the most common complication after shoulder arthroplasty for the treatment of proximal humeral fractures. Additionally, the incidence of nonunion or malunion of the tuberosity has been reported to be between 12.5 and 50 % [4,12,13]. Boileau et al [4] demonstrated that migration and malunion of the greater tuberosity could lead to subacromial impingement, superior migration of the prosthesis, joint stiffness and consistent pain in the shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the incidence of nonunion or malunion of the tuberosity has been reported to be between 12.5 and 50 % [4,12,13]. Boileau et al [4] demonstrated that migration and malunion of the greater tuberosity could lead to subacromial impingement, superior migration of the prosthesis, joint stiffness and consistent pain in the shoulder. A poor greater tuberosity position has also been shown to change the lever arm in the glenohumeral joint abduction, alter the local biomechanical characteristics, accelerate the process of prosthesis and glenoid wear and finally lead to prosthetic failure [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…Primary shoulder arthroplasty for proximal humeral fractures is beneficial for pain relief, but its role in restoring postoperative shoulder function remains controversial [3,4,7,8]. In a study conducted by Neer [9], shoulder arthroplasty was used to treat three-or four-part proximal humeral fractures, whereby over 80 % of the patients obtained a good to excellent result.…”

Section: Discussionmentioning

confidence: 99%

“…According to Boileau et al [4], the greater tuberosity was considered well-positioned in the vertical plane when its summit was between five and ten millimetres below the line, which was tangent to the top of the prosthetic head and perpendicular to the axis of the stem. Otherwise, the greater tuberosity was considered to be vertically malpositioned.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Jiang

2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Shoulder arthroplasty is one of the options for the treatment of complex proximal humeral fractures. The purpose of this study was to assess the clinical and radiographic results of the trabecular metal shoulder prosthesis in the treatment of complex proximal humeral fractures. Methods Fifty-one consecutive patients with complex proximal humeral fractures who underwent primary shoulder arthroplasties with the trabecular metal™ prosthesis were enrolled in this study. At the final follow-up appointment, 42 of the patients (82.4 % of the total patients enrolled) were available for both clinical and radiographic evaluation. There were 28 women and 14 men with a mean age of 65.4±10.7 years. The dominant arm was involved in 30 of the cases. According to Neer's classification, there were seven three-part fractures, 27 four-part fractures and eight head-splitting fractures. Additionally, there were 37 hemiarthroplasties and five total shoulder arthroplasties.Results After a mean follow-up of 37.0±8.4 months (range 24-52 months), the average ranges of motion were: 38.6±15.0°f or external rotation, L3 level for internal rotation and 132.3±36.0°for forward elevation. The mean American Shoulder and Elbow Surgeons, visual analogue scale and University of California, Los Angeles scores were 82.1±14.1, 0.4±1.1 and 28.8±5.1, respectively. The post-operative radiographs exhibited an anatomically attached greater tuberosity in 39 of the 42 shoulders. Of the three patients with greater tuberosity complications, as displayed by their radiographs, two were observed with malpositioned tuberosities, while the other greater tuberosity was resorbed. Proximal migration of the prosthesis was observed in all three shoulders with greater tuberosity complications and in two shoulders with an anatomically attached greater tuberosity. No neurovascular injury, infection or prosthetic loosening was identified during the final follow-up appointments.Conclusions Satisfactory results can be expected with the trabecular metal shoulder prosthesis for the treatment of complex proximal humeral fractures. The post-operative radiographs demonstrated an anatomically healed greater tuberosity in 93 % of the patients at a minimum follow-up time of two years.

show abstract

Proximal humerus fractures

Sánchez-Sotelo

2006

Clinical Anatomy

View full text Add to dashboard Cite

Proximal humerus fractures are common injuries. Knowledge of local anatomy is paramount in the evaluation and treatment of these injuries. Information regarding humeral head vascularity, fracture patterns, bone quality, and overall geometry have direct implications for nonoperative treatment, internal fixation, and hemiarthroplasty. The ascending branch of the anterior circumflex artery perfuses most of the humeral head. When fractured, the greater tuberosity tends to displace posterosuperiorly, the lesser tuberosity and the shaft displace medially, and the head may be pulled by the attached tuberosity, impacted into valgus, or in more severe cases dislocated, impacted, or divided. Internal fixation of two-part, three-part, and selected four-part fractures may be compromised by local osteopenia; knowledge of the location of the strongest bone in the proximal humerus combined with the use of fixed-angle devices and occasionally bone graft or substitutes has improved the outcome of osteosynthesis. When the humeral head cannot be preserved, successful hemiarthroplasty requires tuberosity union and anatomic restoration of the overall geometry of the proximal humerus in terms of height, retroversion, and head-tuberosity relationships.

show abstract

Tuberosity malposition and migration: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus

Cited by 609 publications

References 25 publications

Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Proximal humerus fractures

Contact Info

Product

Resources

About