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General Orthopaedics

Fractures Managed by Reverse Shoulder Arthroplasty

The South African Orthopaedic Association (SAOA) 57th Annual Congress



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:

  • Revision of failed fracture fixation with a deficient rotator cuff – 2 patients;

  • Acute 3 and 4 part fractures in the elderly, osteoporotic – 1 patient;

  • Acute 4 part fracture dislocation in elderly, osteoporotic – 1 patient;

  • Revision of non-union and malunions – 5 patients;

  • 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.