Prothèse inversée d’épaule avec greffe osseuse de la glène pour fracture antérieure de glène associée à une luxation-fracture de l’humérus proximal

Abstract

BackgroundLarge fractures of the anterior glenoid rim can result in persisting instability and osteoarthritis of the glenohumeral joint. When this fracture is associated with a glenohumeral dislocation and proximal humerus fracture could be a concern. The goal of this paper was to evaluate the clinical and radiological outcomes and complications of reverse shoulder arthroplasty (RSA) and glenoid bone graft in cases with a significant anterior glenoid fracture associated with a proximal humerus fracture. HypothesisRSA and step bone graft harvested from proximal humeral head could be a viable option in the treatment of this complex injury. DesignRetrospective case series. Material and methodsTwenty-six patients underwent RSA and glenoid bone graft in a single stage procedure were evaluated at an average 32 months postoperatively. There were 18 women and 8 men with a mean age of 68.5 years (range: 63–75 years). Reverse shoulder arthroplasty with a contoured glenoid bone graft placed underneath the baseplate using humeral head autograft was utilized in all cases. Clinical outcomes were evaluated with range of motion, Constant score and self-reported subjective outcome rated as excellent, good, fair or poor. Radiographic evaluation was performed to evaluate for baseplate displacement or loosening, bone graft union, resorption or collapse. ResultsAt final follow-up, average active elevation was 135° (range: 110°–145°), abduction 122° (range: 60°–160°), and external rotation 30° (range: 0 to 45°). The mean Constant score was 68.2 (range: 54–83). The clinical results were rated as excellent by 15 patients, good by 9, and fair by 2. Radiographic evaluation showed the disc of cancellous bone graft healed without any signs of graft resorption or migration in all 26 cases. No reoperation was performed on any patient in this series. Discussion/ConclusionRSA with glenoid bone grafting produces satisfactory short-term outcomes with acceptable complication rates for treatment of patients greater than 60 years old with proximal humerus fractures associated with an anterior glenoid rim fracture. Further studies are necessary to determine the extended viability of this procedure. Level of evidenceIII.