Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis

Heß, Florian; Bohnert, Laurent; Jaberg, Laurenz; Welter, JoEllen; Pape, Hans-Christian; Sireus, Andrea

doi:10.1007/s00264-020-04831-3

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…Another reasoning factor for overall increased nonunion rates of the GT might be the method of GT fixation. In a recently published report Hess et al 36 demonstrated a tuberosity healing rate of 90% (27/30) by using a new, simple, and reproducible reattachment technique in RSA for patients after PHF. Their rate was much higher than the overall average tuberosity healing rate of 68.3 ± 15.9% (range, 47%−100%) in a recently issued meta‐analysis by Jain et al 37 They attributed the huge variance in tuberosity healing rate to a variable use of fixation techniques and prosthesis types without any further annotation or subgroup classification.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Doll

Neide

Mick

et al. 2022

Journal Orthopaedic Research

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Functional outcome after reverse-shoulder-arthroplasty (RSA) in proximal humerus fractures (PHF) depends on deltoid muscle integrity and successful reattachment of the tuberosities for best possible recovery of rotator-cuff function. In this monocentric, prospective, randomized, controlled trial we investigated whether a reverse-fracture-prosthesis (RFP) with a metaphyseal fenestrated stem achieved superior shoulder and muscle function compared to a common reverse-prosthesis (RP) design for patients with PHF. Our hypothesis was that patients with RFP may achieve a superior healing rate of the greater tuberosity (GT) compared to patients receiving RP, which translates to significantly higher clinical outcome and functional scores as well as differences in deltoid muscle microperfusion. Forty-four patients with PHF were randomized preoperatively to one of the prosthesis types in RSA between 2018 and 2020 (22 with RFP and 22 with RP) and prospectively assessed 6 months after surgery. We assessed osteointegration of the GT with radiographs 1 day and 6 months postoperatively and examined shoulder function and patient satisfaction by using established shoulder scores. A contrast-enhanced ultrasound (CEUS) examination of both shoulders was performed to quantify intramuscular blood flow and evaluate vitality of the deltoid muscle. None of the functional and psychosocial scores or radiographs and ultrasound examinations showed significant differences between the RSA designs. The constant-Murley score (p = 0.384) and active anterior-elevation-abduction, and external rotation were comparable between the RFP and RP group. Similar healing rates of the GT were observed (p = 0.655).CEUS-assessed deltoid microperfusion revealed equivalent muscle vitality for both groups (p = 0.312). Level of evidence: Level II; Randomized Controlled Trial;Treatment Study. Clinical significance: The radiographic evaluation for the investigation of the GT healing rate indicates that the proclaimed benefits of the fracture prosthesis with fenestration design might not be as great as expected.

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Section: Discussionmentioning

confidence: 99%

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Doll

Neide

Mick

et al. 2022

Journal Orthopaedic Research

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“…Fracture specific stems with a 155 • humeral inclination have shown promising results in tuberosity fixation and reduced scapular notching [31,70]. Hess et al used the Global Unite Reverse Fracture (DePuy Synthes, Warsaw, IN, USA) for the management of 3-and 4part proximal humerus fractures in 30 patients with a mean age of 79 years.…”

Section: Influence Of Implant Designs On Tuberosity Healingmentioning

confidence: 99%

“…Ten percent of patients developed scapular notching over a 1-year follow-up. [70]. Thus, the Global Unite Reverse Fracture stem may offer satisfactory clinical outcomes with reliable tuberosity union.…”

Section: Influence Of Implant Designs On Tuberosity Healingmentioning

confidence: 99%

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Borbas

Grubhofer

et al. 2021

JCM

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Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.

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“… 15 , 29 , 41 , 43 The most frequent complications are implant instability (1.5%-31%) and reabsorption, nonunion, or malunion of the tuberosities (16%-60%). 6 , 14 , 22 , 24 , 25 , 35 In addition, nonunion of the tuberosities can cause subsequent loss of external and internal rotation and subacromial impingement. 7 , 25 , 36 , 39 …”

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confidence: 99%

Surgical learning curve in reverse shoulder arthroplasty for proximal humerus fractures

Blaas¹,

Yuan²,

Lameijer³

et al. 2021

JSES International

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Background Fracture reverse shoulder arthroplasty (fRSA) in geriatric, complex dislocated proximal humerus fractures is becoming the standard treatment next to conservative treatment. fRSA is a multifaceted, reasonably challenging procedure of which functional outcomes and complication rates are likely to depend on the experience of the surgeon. The goal of this study was to determine whether there is a learning curve for fRSA. Methods All patients with a dislocated multipart proximal humerus fracture that were treated with an fRSA between 2013 and 2019 in a specialized institution were included. The functional outcomes (Constant Shoulder Score, Oxford Shoulder Score, and range of motion), complications, and operation time of fRSA were assessed with linear regression plots and cumulative summation analysis to establish whether a learning curve was present. Results In this cohort study, 50 patients were included. They had a mean age of 77.1 years and were treated with an fRSA by one trauma surgeon. Learning curves were distinguished for functional outcomes, complications, and operation time based on learning targets for daily activity and the mean complications and operation time. Results indicated that an optimal treatment is achieved after performing 20 fRSAs. Conclusion The results show that functional outcomes of PHFs treated with an fRSA improve with surgical experience. Also, outcomes are getting less variable after about 20 procedures. Surgeons starting this procedure should be aware of the learning curve and, therefore, should consider guidance from an experienced surgeon to swiftly optimize functional outcomes and prevent unnecessary complications.

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Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis

Cited by 5 publications

References 34 publications

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Surgical learning curve in reverse shoulder arthroplasty for proximal humerus fractures

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