Introduction: The treatment of Complex Proximal Humeral Fractures and Fractures associated with Dislocation is not still resolved. Internal Fixation sometimes is not possible due to comminuted and osteoporotic bone which is commonly found in this kind of Fractures. The use of Hemiarthroplasty in this situation, not always achieves a good functional outcome, usually related to a Non Union or Malunion of the Tuberosities. We began using Reversed Shoulder Arthroplasty in this Fractures due to good results this implant had had in Glenohumeral Arthritis associated a Rotator Cuff Deficiency.

Material and Methods: From January 2004 to December 2008 we have treated 50 patients with Complex Proximal Humeral Fractures with a Reversed Shoulder Arthroplasty,38 were women and 12 were men with a mean age of 76 (38–84). The mean follow-up time was 20 months (10–36). We have used a Lima Reversed Arthroplasty in all the cases. The dominant arm were involved in 65 % of the patients. The Deltopectoral approach were used in all the cases. Thirty-five patients (70 %) were treated in less than 30 days after the fracture and 15 (30 %) were treated 30 days or more since the fracture happened. The operations were performed by 6 surgeons, but only 3 of them have performed more than 10 operations.

We used the Constant Score and the American Shoulder and Elbow Score to evaluate the outcome of the implant. The preoperative movement were estimated on the mobility score of the contralateral shoulder.

Results: The mean Constant and the mean modified Constant Score were 55 (23 to 73) and 70 (34 to 95). The average range of motion was 105 (45–140) for anterior elevation and 100 (35–125) for abduction. The mean modified American Shoulder and Elbow Surgeon was 64 (44–82).

The average operation time was 105 minutes with a range (60–170).

The main clinical complications has been: Three intraoperative Fractures of Glenoid, 2 post operative Glenoid Fractures, 2 Brachial Plexus Paralysis, 2 cases of Cubital Neuroapraxia, 2 Dislocations of the Prosthesis,2 superficial infections and 1 deep infection.

Radiography it has been found Scapular Notch in 17 patients (34%), Periprothesic Calcification in 42 (84 %) and migration of the Tuberosities in 22 (44%).

Conclusions: We have had better results in acute situations than chronics ones. Most of the complications occurs in the group of patients treated in more than 30 days since the Fracture has happened.

The Reverse Shoulder Arthroplasty is an alternative to the Hemiarthroplasty, and an important tool which an Orthopaedic Trauma Surgeon has to consider, to resolve this kind of Fractures specially in elderly patients.

Introduction and Objectives: Non-unions of long bones represents a challenge for the orthopaedic surgeon due to the difficulty of treatment and high use of resources (human, surgical, etc.) which certainly raises health care costs. The development of morphogenetic proteins for the treatment of this clinical condition provides a powerful means of achieving the desired result: consolidation of the non-union.

Materials and Methods: From June 2002 to May 2003, we treated 5 cases of non-union of long bones (2 of the humerus, 1 femur, 1 tibia, and one knee arthrodesis). The group included 3 males and one female, ranging in age from 23 to 71 years (mean 47.2 years). Three of the subjects had previously undergone surgery between 1 and 7 times. One case presented with a bone defect in the distal third of the humerus. All cases were treated using mechanical stabilisation of the fracture. In one case, a bone bank graft was used, and in another, an autologous graft was used.

Results: Bone healing was achieved in all cases, except in one humerus.

Discussion and Conclusions: BMP-7 (OP-1) appears to be an advance in the treatment of long bone non-unions. Though it does not eliminate the need for adequate surgical treatment of non-unions (resection of the focus, exposure until bleeding bone, and mechanical stabilisation), this method does favor osteogenesis at the fracture site and avoids the morbidity associated with extraction of autologous bone from the iliac crest.