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Delta III reverse shoulder arthroplasty in the treatment of complex 3- and 4-part fractures of the proximal humerus: 6 to 42 months of follow up.

Mattiassich G, Marcovici LL, Krifter RM, Ortmaier R, Wegerer P, Kroepfl A - BMC Musculoskelet Disord (2013)

Bottom Line: It has been proposed that RSA has more benefits than other treatment options.No statistical difference was noted between age and clinical outcome.Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: There is a growing tendency for complex proximal humerus fractures (PHF) in osteoporotic patients to be treated with reverse shoulder arthroplasty (RSA). It has been proposed that RSA has more benefits than other treatment options. The aim of our study was to investigate preoperative characteristics as well as clinical and radiological outcomes in patients with complex 3- or 4-part PHF who had undergone primary RSA.

Methods: Patients with a minimum follow-up of 6 months who had undergone a primary RSA after 3- or 4-part PHF in the period between 2008 and 2011 were eligible for the study. Clinical records, X-rays and CT-scans were investigated and a clinical examination was performed. Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant-Murley score (CMS) were calculated. Sixteen patients were examined as part of the study. The mean follow-up was 20 months (range 6-42 months). According to Codman-Hertel classification we encountered 15 Hertel "12" and 1 Hertel "8" type fractures.

Results: Thirty-two patients (27 female - 84.4%) with a mean age of 72 years underwent operations to treat complex 3- and 4-part fractures of the proximal humerus. Sixteen patients were reexamined. In 14 cases the dominant upper extremity was on the right, in 2 cases it was on the left, in 6 cases the right side was affected and in 10 cases the left side was affected. The mean CMS was 54.8 (range 18-95) and the mean DASH was 37.5 (range 2.9-81). A trend was established between the CMS and dominance of the affected shoulder. The CMS was better if the affected shoulder was on the non-dominant side (p-value 0.051). No statistical difference was noted between age and clinical outcome.

Conclusions: Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA. RSA can provide immediate relief and good shoulder function in elderly patients. Nevertheless, the question of longevity of these implants remains to be observed.

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Related in: MedlinePlus

X-ray after trauma (a.-p.-view).
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Figure 1: X-ray after trauma (a.-p.-view).

Mentions: All fractures were attributed to C-type according to AO-classification. According to Neer classification, 15 4-part fractures and 1 3-part fracture were encountered. According to Codman-Hertel classification, we encountered 15 Hertel “12” and 1 Hertel “8” type fractures (Figures 1,2,3). Eight fractures were dislocated anteriorly and 8 posteriorly. 14 had a posteromedial metaphyseal hinge greater than 8 mm. Seven humeral heads were dislocated in valgus and in 3 cases the head presented splitting of more than 20%.


Delta III reverse shoulder arthroplasty in the treatment of complex 3- and 4-part fractures of the proximal humerus: 6 to 42 months of follow up.

Mattiassich G, Marcovici LL, Krifter RM, Ortmaier R, Wegerer P, Kroepfl A - BMC Musculoskelet Disord (2013)

X-ray after trauma (a.-p.-view).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750557&req=5

Figure 1: X-ray after trauma (a.-p.-view).
Mentions: All fractures were attributed to C-type according to AO-classification. According to Neer classification, 15 4-part fractures and 1 3-part fracture were encountered. According to Codman-Hertel classification, we encountered 15 Hertel “12” and 1 Hertel “8” type fractures (Figures 1,2,3). Eight fractures were dislocated anteriorly and 8 posteriorly. 14 had a posteromedial metaphyseal hinge greater than 8 mm. Seven humeral heads were dislocated in valgus and in 3 cases the head presented splitting of more than 20%.

Bottom Line: It has been proposed that RSA has more benefits than other treatment options.No statistical difference was noted between age and clinical outcome.Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: There is a growing tendency for complex proximal humerus fractures (PHF) in osteoporotic patients to be treated with reverse shoulder arthroplasty (RSA). It has been proposed that RSA has more benefits than other treatment options. The aim of our study was to investigate preoperative characteristics as well as clinical and radiological outcomes in patients with complex 3- or 4-part PHF who had undergone primary RSA.

Methods: Patients with a minimum follow-up of 6 months who had undergone a primary RSA after 3- or 4-part PHF in the period between 2008 and 2011 were eligible for the study. Clinical records, X-rays and CT-scans were investigated and a clinical examination was performed. Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant-Murley score (CMS) were calculated. Sixteen patients were examined as part of the study. The mean follow-up was 20 months (range 6-42 months). According to Codman-Hertel classification we encountered 15 Hertel "12" and 1 Hertel "8" type fractures.

Results: Thirty-two patients (27 female - 84.4%) with a mean age of 72 years underwent operations to treat complex 3- and 4-part fractures of the proximal humerus. Sixteen patients were reexamined. In 14 cases the dominant upper extremity was on the right, in 2 cases it was on the left, in 6 cases the right side was affected and in 10 cases the left side was affected. The mean CMS was 54.8 (range 18-95) and the mean DASH was 37.5 (range 2.9-81). A trend was established between the CMS and dominance of the affected shoulder. The CMS was better if the affected shoulder was on the non-dominant side (p-value 0.051). No statistical difference was noted between age and clinical outcome.

Conclusions: Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA. RSA can provide immediate relief and good shoulder function in elderly patients. Nevertheless, the question of longevity of these implants remains to be observed.

Show MeSH
Related in: MedlinePlus