Fracture-Specific and Conventional Stem Designs in Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures-A Retrospective, Observational Study.

Philipp Moroder,Markus Scheibel,Jan-Philipp Imiolczyk

doi:10.3390/jcm10020175

Abstract

Tuberosity healing and stem design can be outcome-dependent parameters in hemiarthroplasty for proximal humerus fractures (PHF). The relevance of fracture-specific stem design in reverse shoulder arthroplasty (RSA) is still a matter of debate. This retrospective study evaluates tuberosity healing and function for fracture specific stems (A) compared to conventional stems (B) in RSA for complex PHF in 26 patients (w = 21, mean age 73.5 years). Clinically, range of motion (ROM), Constant-Murley-Score (CS), Subjective Shoulder Value (SSV), and external rotation lag signs (ERLS) were evaluated. Healing of greater tuberosity (GT) and lesser tuberosity (LT), scapular notching, and loosening were examined radiologically. There were no statistical significant differences with regards to CS (A: 73 ± 11; B: 77 ± 9 points), SSV (A: 78% ± 11%; B: 84% ± 11%), external rotation (A: 18° ± 20°; B: 24° ± 19°), or internal rotation (A: 5.7 ± 2.2; B: 6.7 ± 2.8 CS-points) (p > 0.05). Mean forward flexion was superior for group A (p = 0.036). Consolidation of GT (82%) and LT (73%) was similar in both groups. Anatomical healing was slightly higher in group B (p > 0.05). Scapular notching was found in 27% (A) and 55% (B) (p > 0.05). RSA for PHF provides good to excellent clinical results. The quantitative and qualitative union rate for both cohorts was similar, indicating that fracture stems with open metaphyseal designs to allow for bone ingrowth do not improve tuberosity healing. ERLS correlates with a worse function in CS and ROM in all planes.

Highlights

Accounting for approximately 5% of all fractures, proximal humerus fractures (PHF)are one of the most common fractures shoulder surgeons must take care of
Patients received a Grammont type of prosthesis (155◦ of humeral inclination) with either a fracture specific stem design with open metaphysis allowing for bone ingrowth
Seven patients had to be excluded from the final evaluation due to death (n = 5) or limited general health status prohibiting an outpatient clinic visit (n = 2)

Summary

Introduction

Accounting for approximately 5% of all fractures, proximal humerus fractures (PHF). Are one of the most common fractures shoulder surgeons must take care of. The incidence of PHF increases with age [1]. Most fractures only show minimal displacement and can be treated conservatively. More complicated and dislocated fractures though, often require surgical treatment [2,3]. Hemiarthroplasty (HA) was considered the standard surgical option for non-reconstructable fractures due to poor bone quality and a high risk of non-union, dislocation, or osteonecrosis when treated with open reduction and internal fixation (ORIF) [4,5,6,7]. In the last few years reverse shoulder arthroplasty (RSA)

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