Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty?

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• 作者：Gokcer Uzer ; MD^a ; Fatih Yildiz ; MD^a ; Suat Batar ; MD^a ; Ruwais Binlaksar ; MD^b ; Mehmet Elmadag ; MD^a ; Gamze Kus ; Msc Pt^c ; Kerem Bilsel ; MD ; FEBOT^a ; ^{kbilsel@gmail.com}
• 关键词：Level III ; Retrospective Cohort Design ; Treatment Study
• 刊名：Journal of Shoulder and Elbow Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：26
• 期：1
• 页码：36-41
• 全文大小：982 K
• 卷排序：26

文摘

Functional outcomes of reverse total shoulder arthroplasty (rTSA) can be improved by fixation of the tuberosities. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures treated with rTSA, with and without autologous grafting.MethodsThirty-three patients with proximal humeral fractures were treated with rTSA and tuberosity fixation. In 18 patients (group I; mean age, 75 years), tuberosity fixation was augmented with autografting; in 15 patients (group II; mean age, 71 years), graft augmentation was not used. The mean follow-up was 16.7 (range, 12-24) months in group I and 16.8 (range, 12-25) months in group II.ResultsRadiologic tuberosity union was achieved in 14 of 18 (77.8%) patients who underwent autograft augmentation and in 6 of 15 (40.0%) patients treated without autografting. The mean American Shoulder and Elbow Surgeons (ASES) score was 69.6 ± 13.0 in group I and 51.0 ± 20.0 in group II. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 31.9 ± 24.0 in group I and 58.2 ± 24.6 in group II. A significant difference was detected between groups for ASES and DASH scores. Among shoulder range of motion measures, only forward flexion differed significantly between groups I and II (124° ± 23° vs. 98° ± 30°, respectively). External rotation muscle strength was significantly higher in group I (3.36 ± 1.46 kg) than in group II (2.39 ± 2.00 kg).ConclusionIn the treatment of complex proximal humeral fractures in elderly patients by rTSA, cancellous block autograft augmentation can increase the rate of tuberosity union and improve functional outcomes.