Reverse total shoulder arthroplasty for treatment of complex proximal humeral fractures

Abstract

Objective To evaluate the clinical results of reverse total shoulder arthroplasty for the treatment of complex proximal humeral fractures.Methods From August 2008 to August 2012,40 consecutive patients underwent reverse total shoulder arthroplasty for the treatment of complex proximal humeral fracture and were followed up for no less than one year.They were 8 men and 32 women with an average age of 73.4 years (range,67 to 86 years).The dominant side was affected in 24 patients.Of the 30 patients with fresh fracture or fracture-dislocation,the average duration from injury to surgery was 11.4 days; 5 were three-part,22 fourth-part and 3 head-split by the Neer classification.Of the 10 patients with obsolete fracture or fracture-dislocation,the average duration from injury to surgery was 509.0 days; 7 were complicated with locking dislocation,and 3 old fracture nonunion or malunion.Results The mean follow-up time was 24.9 months (range,12 to 60 months).At the last follow-up,the forward elevation averaged 134.9°,external rotation 24.7° and internal rotation the L3 level.The visual analogue scale (VAS) pain score averaged 0.9 (from 0 to 5),American Shoulder and Elbow Surgeons (ASES) score 77.3 (from 50 to 98),Constant-Murley score 73.4 (from 44 to 90),and University of California at Los Angeles (UCLA) score 28.1 (from 19 to 34).One patient was found with stress fracture of the acromion postoperatively.There were no complications like infection,prosthetic loosening or neurovascular injury related to the surgery.Conclusion Reverse total shoulder arthroplasty for complex proximal humeral fractures may yield good clinical results with a high healing rate of tuberosities. Key words: Shoulder fractures; Arthroplasty, replacement; Prostheses and implants