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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 421 - 421
1 Nov 2011
Cazeneuve J Hasssan Y Hilaneh A Kermad F Brunel A
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Synthesis and hemi-prosthesis give well known radiological results for acute proximal complex humeral fractures in elderly population. We wanted to expose the radiological outcome of the reverse concept in this indication.

From 1993 to 2008, forty four DELTA III were implanted for thirty three three-part and four-part displacements and eleven fracture-dislocations, in 3 males for 41 females, with an average age of seventy five years. The results were estimated with AP and LAMY profile Xrays.

Because of ten deceases and three moving, thirty one cases were reviewed with a mean follow-up of 6.3 years, range 1 to 15. The radiographs showed : two 2-mm thick borders on the glenoid at four and eight years with a scapular notch at 11 years and an aseptic loosening of the base plate at 12 years with a broken polar inferior screw. The patient underwent an easy surgical revision because of a fair bone stock. There was no wear of the polyethylene.

According to the NEROT classification, nineteen inferior scapular notches were observed with a mean occurrence time of 4.6 years. The seven type-1 notches appeared at a mean of 2 years and the five type-2 notches at a mean of 4.3 years. We observed four type-3 notches which reached the inferior screw at 5,6,7 and 8 years, and three type-4 notches which extended beyond the inferior screw at 6,7 and 8 year follow-up, respectively. There seem to be two distinct patters of notches: mechanical, stable proximal humeral bone loss because of an impingement between the humeral component and the inferior scapular pillar and biological, progressive in size, evolving over time with proximal humeral bone loss because of polyethylene disease; the longer the follow-up, the more severe the notch. Fourteen inferior spurs, stable after emergence, were reported with a mean occurrence time of 2.5 years range 1 to 6 years. One joint ossification occurred at 6 months and was stable at 6 year follow-up. The humeral results consisted in five medial (5,6,710, and 11 years) proximal bone looses and three bone-cement interface medial borders on the two thirds of the height of the stem at a mean follow-up of 5 years. In these eight cases, there was a notch associated. We reported one case of septic humeral loosening at 2 year follow-up.

For acute proximal humeral complex fractures in elderly population, when re-fixation of the tubercles on the classical orthopaedics devices is impossible, the use of a DELTA III prosthesis shows, with a mean follow-up of 6.3 years, worrying images in 70% of the cases.

These images are on the glenoid in 70% of the cases, appeared before seven years in 86% and are progressive in 50% of the cases. But, we have only one re-intervention for an aseptic loosening of the base plate at a twelve year evolution. New developments in design and bearing surfaces and a more long term results will probably provide more durable utilization of the reverse concept in this indication.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 121 - 121
1 Mar 2010
Cazeneuve J Hasssan Y Kermad F Brunel A
Full Access

Synthesis and hemi-prosthesis give well known radiological results for acute proximal complex humeral fractures in elderly population. We wanted to expose the radiological outcome of the reverse concept in this indication.

From 1993 to 2007, forty one DELTA III were implanted for thirty two three-part and four-part displacements and nine fracture-dislocations, in 3 males for 38 females, with an average age of seventy five years. The results were estimated with AP and LAMY profile X-rays.

Because of nine deceases and two moving, thirty cases were reviewed with a mean follow-up of 6.5 years, range 1 to 14. The radiographs showed: two 2-mm thick borders on the glenoid at four and eight years with a scapular notch at 11 years and an aseptic loosening of the base plate at 12 years with a broken polar inferior screw. The patient underwent an easy surgical revision because of a fair bone stock. There was no wear of the polyethylene. According to the NEROT classification, seventeen inferior scapular notches were observed with a mean occurrence time of 4.7 years. The seven type-1 notches appeared at a mean of 2 years and the five type-2 notches at a mean of 4.3 years. We observed three type-3 notches which reached the inferior screw at 5,6 and 7 years, and two type-4 notches which extended beyond the inferior screw at 6 and 7 years follow-up, respectively. There seem to be two distinct patters of notches: mechanical, stable proximal humeral bone loss because of an impingement between the humeral component and the inferior scapular pillar and biological, progressive in size, evolving over time with proximal humeral bone loss because of polyethylene disease; the longer the follow-up, the more severe the notch. Fourteen inferior spurs, stable after emergence, were reported with a mean occurrence time of 2.5 years range 1 to 6 years. One joint ossification occurred at 6 months and was stable at 6 year follow-up. The humeral results consisted in four medial (5,6,7 and 10 years) proximal bone looses and two bone-cement interface medial borders on the two thirds of the height of the stem at 5 year follow-up. In these six cases, there was a notch associated. We reported one case of septic humeral loosening at 2 year follow-up.

For acute proximal humeral complex fractures in elderly population, when re-fixation of the tubercles on the classical orthopaedics devices is impossible, the use of a DELTA III prosthesis shows, with a mean follow-up of 6.5 years, worrying images in 70% of the cases. These images are on the glenoid in 70% of the cases, appeared before seven years in 86% and are progressive in 50% of the cases. But, we have only one re-intervention for an aseptic loosening of the base plate at a twelve year evolution. New developments in design and bearing surfaces and a more long term results will probably provide more durable utilization of the reverse concept in this indication.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 276 - 276
1 Jul 2008
CAZENEUVE J BRUNEL A KERMAD F HASSAN Y
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Purpose of the study: Hemi-arthroplasty, osteosynthesis, and ball-and-socket implants provide well-known results for the management of displaced joint fractures of the proximal humerus in elderly subjects. The purpose of this work was to assess the reversed Grammont prosthesis for these indications.

Material and methods: From 1993 to 1999, eighteen Delta III prostheses were implanted by the same operator in recent trauma victims. The patients, 17 women and one man, mean age 75 years, presented four-fragment fractures (n=15) or fracture dislocation (n=3). The dominant side was involved in nine cases. These patients presented infiltrative rotator cuff tendinopathy (n=4), type 1 diabetes mellitus (n=2), exogenosis (n=2), morbid obestity (n=2), homelessness (n=2), and dementia (n=2). Surgery was performed under general anesthesia in the semi-sitting position via a trapezodeltoid approach without acromion osteotomy and with 20° humeral implant retroversion in all cases except one, cemented in 17 cases. The tubercles could be reinserted in four patients. Rehabilitation was not always possible. The Constant score and the anteroposterior and Lamy lateral views were used to assess clinical and radiographic outcome.

Results: There were two deaths, so the analysis included 16 shoulders. Complications were: shoulder-hand syndrome (n=1), early deep Acinetobacter infection with revision and preservation of the arthroplasty (n=1), anterior dislocation at one month due to voluntary 10° anterotation of the humeral stem requiring reorientation (n=1). At mean follow-up of 85 months, the Constant score was 60, with a weighted score of 83%. The results were not influenced by reinsertion of the tubercles and were considered good for pain and activity, fair for strength, and disappointing for rotations. The x-rays did not reveal any sign of humeral loosening. There was one lucent line between the glenoid and the metaglenoid, four cases with pillar notches, and nine infraglenoid ossifications.

Discussion and conclusion: For displaced joint fractures of the proximal humerus, endomedullary osteosynthesis and the ball-and-socket implant have shown their efficacy as an alternative to hemiarthroplasty. The reverted prosthesis also appears to be a valid therapeutic option for elderly persons with osteoporotic bone compromising the reinsertion of the tubercules. This option enables good results for pain, activity, strenth and active mobility except for rotation, with only five signs of gravity for the glenoid with one involving the glenoid and none the humerus at 85 months follow-up. These results should be further confirmed with a larger series and longer follow-up.