Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus

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• 作者：Florian Grubhofer ; MD ; Karl Wieser ; MD ; Dominik C. Meyer ; MD ; Sabrina Catanzaro ; RRN ; Katharina Schü ; rholz ; MS ; Christian Gerber ; MD ; FRCSEd (Hon) ; ^{christian.gerber@balgrist.ch}
• 关键词：Level IV ; Case Series ; 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：92-100
• 全文大小：1484 K
• 卷排序：26

文摘

Open reduction and internal fixation (ORIF) of complex fractures of the proximal humerus may yield unsatisfactory results. This study analyzed the results obtained after revision of failed ORIF of proximal humeral fractures using reverse total shoulder arthroplasty (RTSA).MethodsFifty-four shoulders of 53 patients with a subjectively unacceptable outcome after ORIF of a complex fracture of the proximal humerus were revised with RTSA. At a minimum follow-up of 2 years (mean follow-up, 46 months; range, 24-108 months), 44 shoulders were clinically and radiographically reviewed for the purpose of this study. Six patients had been lost to follow-up, and 4 patients (7%) were excluded from functional analysis because of revision surgeries.ResultsThe mean absolute Constant score improved from 26 (range, 4-54) to 55 (range, 19-80) points; the mean relative Constant score improved from 32% (range, 4%-85%) to 67% (range, 27%-94%) of an age- and gender-matched, normal shoulder. The mean subjective shoulder value improved from 29% (range, 0%-90%) preoperatively to 67% (range, 5%-95%) at final follow-up. Nineteen patients rated their outcome excellent, 16 good, and 7 fair; 2 patients were dissatisfied.ConclusionRTSA is a valuable salvage procedure after failed ORIF of a proximal humeral fracture with relatively low revision rates. Shoulder function, patient satisfaction, and pain levels can be reliably improved.