[Shoulder arthroplasty in traumatological indications, long-term results].
OBJECTIVE
To evaluate the long-term results of shoulder arthroplasty in trauma cases, using ProSpon and MMS-M.I.L. novel systems.


METHODS
The shoulder endorosthesis designed by the authors, and manufactured as two products by ProSpon (Czech Republic) and MIL (France) companies, was used in surgical treatment of 43 cases of acute fractures and 33 cases of post-traumatic conditions. The Constant score was used to evaluate the clinical outcome.


RESULTS
In patients with acute trauma, the average Constant score was 59 points (range, 23-82). The average maximal elevation was 88 degrees (range, 40-140). No postoperative pain, mild pain at strain and arm activity-limiting pain were recorded in 25%, 72% and 3% of the patients, respectively. In patients with post-traumatic destruction of the shoulder, the average Constant score was 53.5 points (range, 20-88) and the average maximal elevation was 85 degrees (range, 30-130). No pain, mild pain and activity-limiting pain were present in 36%, 52% and 12% of the patients, respectively. The patients in whom the reconstruction of the proximal humerus and rotator cuff was performed with the use of a special toothed plate and screws, as designed by the authors, the overall average Constant score was higher by 12 and 11 points for acute trauma and post-traumatic destruction, respectively, when compared with the conventional technique of reconstruction by suture. Two serious complications were recorded, namely, a failure of the reconstruction due to splitting of the greater tubercle fragment at the site of plate fixation and an instability of the shoulder. In patients who were indicated for shoulder arthroplasty due to post-traumatic destruction, the average increase in the Constant score was 12 points in comparison with the pre-operative status.


CONCLUSIONS
Our results of shoulder arthroplasty in acute injury to the proximal humerus are in agreement with the results published in the literature. In reconstruction of the tubercles, there was a considerable difference in results between our screws-and-plate technique and the conventional suture method. With the former, the average Constant score was higher by 12 and 11 points and the average active elevation was better by 15 and 10 degrees for acute trauma and post-traumatic destruction, respectively. Clinical observations also show that osteosynthesis of the tubercle, particularly of the greater one, has better stability with the use of screws and plate, rehabilitation is associated with less pain and shoulder motion improves more rapidly.


CONCLUSIONS
The results presented here are comparable with those reported in the literature. In the group treated by the technique designed by the authors, the outcomes are markedly better. This technique of shoulder reconstruction provides better stability for attachment fixation of the rotator cuff, facilitates reconstruction of the proximal humerus in acute trauma and restoration of biomechanical properties of the shoulder joint.
Pokorný
D
D
I. Ortopedická klinika 1. LF UK, FN Motol, Praha.
Sosna
A
A
Vavrík
P
P
Jahoda
D
D
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*