Abstract
Reverse Shoulder Arthroplasty (RSA) has been widely accepted for the treatment of rotator cuff arthropathy. There are a number of other shoulder pathologies where the reverse shoulder prosthesis can salvage previously untreatable shoulder conditions and restore function to the shoulder. This is a series of cases where RSA has been used to treat shoulder fractures.
Material.
Our indications for the reverse prosthesis in fracture management were:
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Revision of failed fracture fixation with a deficient rotator cuff – 2 patients;
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Acute 3 and 4 part fractures in the elderly, osteoporotic – 1 patient;
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Acute 4 part fracture dislocation in elderly, osteoporotic – 1 patient;
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Revision of non-union and malunions – 5 patients;
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Revision of hemiarthroplasties which were initially done for fracture management – 5 patients.
Results.
There were a total of 14 cases treated for fractures out of 123 reverse shoulder arthroplasties performed. The average age for the fracture cases was 68 years (range 47–87) and for non-fracture RSA cases 73 years (range 51–88). The average follow-up Constant Score was 53 for fracture cases and 67 for non-fracture RSA cases.
Complications included 1 dislocation and 1 deep infection. The problem with treatment of complex cases is there is an increased risk of complications.
Problems encountered in the use of reverse shoulder arthroplasty in complex diagnoses include: instability, notching of scapula, scapula fractures, sepsis, lack of bone stock, poor quality soft-tissue and deficient deltoid muscle due to numerous previous surgical procedures, distortion of anatomy due to trauma, subscapularis deficiency and problems encountered from metal implants in situ.
Conclusion.
RSA is a good salvage procedure for cuff deficient shoulder fracture cases.
