Abstract
BACKGROUND:
Bony healing of tuberosities around shoulder prostheses is difficult to obtain in the elderly patient. We hypothesized that reattachment of the tuberosities, performed in combination with bone grafting, around a specific reverse shoulder fracture-prosthesis (RSFP) would favour improved tuberosity healing and shoulder mobility in elderly patients with displaced proximal humerus fractures.
METHODS:
We included 49 patients (50 shoulders)(45 female, 4 male) in this prospective study. Mean (± SD) age 80 ± 4 years (range, 70–88). Clinical evaluation consisted of ROM, VAS (pain), Constant scores, patient satisfaction (Subjective Shoulder Value (SSV)) and noted complications. Radiological evaluation consisted of tuberosity healing and component loosening. Mean follow-up 18 ± 8 months (12–39).
RESULTS:
Mean active mobility was 131 ± 29° (40–170°) for anterior elevation, 24 ± 14° (0–50°) for external rotation, and 5 ± 3 points (0–10) for internal rotation. Mean VAS for pain 1 ± 1 point/10 (0–4). Mean Constant scores were 64 ± 15 points (31–91) and 93 ± 23% (45–142%). Mean SSV was 70 ± 5% (50–90%). Two complications were recorded, but no patient required further surgery. Forty-four shoulders (88%) had complete radiographic greater tuberosity healing, 5 migration and 1 resorption. Two cases with grade 1 notching. Eighteen cases with a glenoid spur and no glenoid or humeral loosening was observed.
CONCLUSIONS:
In spite of advanced patient age, tuberosity healing can be achieved by reattachment and bone grafting around a specific Reverse Fracture prosthesis. Successful peri-prosthetic tuberosity healing is associated with restoration of active elevation and external rotation. Postoperative complications frequently encountered with conventional reverse shoulder prostheses (instability, infection, humeral resorption) were not observed in this series.
