Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus

• Published in: Journal of shoulder and elbow surgery 2017-01, Vol.26 (1), p.92-100
• Main Authors: Grubhofer, Florian, MD, Wieser, Karl, MD, Meyer, Dominik C., MD, Catanzaro, Sabrina, RRN, Schürholz, Katharina, MS, Gerber, Christian, MD, FRCSEd (Hon)
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; extracapsular fracture sequelae; failed ORIF; Female; Fracture Fixation, Internal; Humans; intracapsular fracture sequelae; Male; Middle Aged; Open Fracture Reduction; Orthopedics; Patient Satisfaction; Radiography; Range of Motion, Articular; Reoperation; Retrospective Studies; RTSA; salvage therapy; screw cutout; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - physiopathology; Shoulder Fractures - surgery; Treatment Failure
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2016.05.020

Background Open reduction and internal fixation (ORIF) of complex fractures of the proximal humerus may yield unsatisfactory results. This study analyzed the results obtained after revision of failed ORIF of proximal humeral fractures using reverse total shoulder arthroplasty (RTSA). Methods Fifty-four shoulders of 53 patients with a subjectively unacceptable outcome after ORIF of a complex fracture of the proximal humerus were revised with RTSA. At a minimum follow-up of 2 years (mean follow-up, 46 months; range, 24-108 months), 44 shoulders were clinically and radiographically reviewed for the purpose of this study. Six patients had been lost to follow-up, and 4 patients (7%) were excluded from functional analysis because of revision surgeries. Results The mean absolute Constant score improved from 26 (range, 4-54) to 55 (range, 19-80) points; the mean relative Constant score improved from 32% (range, 4%-85%) to 67% (range, 27%-94%) of an age- and gender-matched, normal shoulder. The mean subjective shoulder value improved from 29% (range, 0%-90%) preoperatively to 67% (range, 5%-95%) at final follow-up. Nineteen patients rated their outcome excellent, 16 good, and 7 fair; 2 patients were dissatisfied. Conclusion RTSA is a valuable salvage procedure after failed ORIF of a proximal humeral fracture with relatively low revision rates. Shoulder function, patient satisfaction, and pain levels can be reliably improved.