Reverse Shoulder Arthroplasty with <i>Latissimus Dorsi</i> Transfer for Humerus Fractures Sequelae

Abstract

Relevance. Fractures of the proximal humerus occupy the 3rd place in the structure of fractures in the elderly. Failure to treat these injuries leads to irreversible changes in the shoulder. The main treatment for the latter is arthroplasty. The surgical treatment of this category of patients is still a difficult task. The purpose of this study was to compare the effectiveness of standard reverse arthroplasty with reverse arthroplasty in combination with the reconstruction of the external rotators of the shoulder or transposition of the latissimus dorsi. Materials and Methods. The retrospective evaluation of treatment results of 96 patients with consequences of shoulder injuries was conducted. Of these, 51 patients underwent standard reverse arthroplasty (group I), and 45 patients (group II) underwent arthroplasty with reconstruction of the external rotators of the shoulder or transposition of the latissimus dorsi. The female patients accounted for 68.8%. The duration of the injury varied from 8 months to 2.5 years, the follow-up — from 1 to 7 years (Me = 3.5). The results were assessed with VAS, ASES, UCLA scales. Results. The positive outcomes were observed in most patients. Complications: dislocations of the endoprosthesis occurred in 16.7%, infectious complications — in 5.2%, shoulder component instability — in 2.1%, fracture of the humeral diaphysis — in 3.1%, neurovascular bundle injury — in 2.1% of cases. In the patients of group I, dislocations occurred significantly more often than in the patients of group II. To reduce the risk of complications, a rational tactic has been developed for treating patients with consequences of shoulder injuries. If electroneuromyography values from the deltoid muscle were less than 40% of the contralateral side, or if mineral bone density T-score was less than 2.5 SD, arthroplasty was not performed. During arthroplasty, it is necessary to perform the direct suturing of the of the infraspinatus and teres minor tendons to the humerus. If it is impossible, the latissimus dorsi transfer is indicated. Conclusion. Reverse arthroplasty in the treatment of the humerus fractures sequelae is an effective technique. To reduce the risk of complications, it is necessary to provide the additional stability of the endoprosthesis by reconstruction of the external rotators or latissimus dorsi transfer. It is advisable to refrain from arthroplasty in cases of severe deltoid hypotrophy and severe osteoporosis.