title: Reverse shoulder prosthesis for acute four-part fracture: tuberosity fixation using a horseshoe graft.
abstract: Results of hemiarthroplasty for complex four-part proximal humerus fractures in the elderly have been unreliable. Although patients often achieve pain relief, return of above-shoulder level function can be challenging, because tuberosity nonunion, malunion, and/or resorption is quite common. The reverse shoulder replacement has been advocated as a reliable alternative for these patients. Preliminary studies have suggested that tuberosity healing is critical for achieving external rotation strength after reverse shoulder arthroplasty. We describe a technique of tuberosity repair using a wedge horseshoe graft, which can provide improved surface area for tuberosity healing. A clinical series of seven patients treated with this technique is reported with a minimum follow-up of 12 months (range, 12-23 months). The tuberosity union rate was 86% (six of seven patients). Average active forward elevation was 117° (range, 95°-150°), and active external rotation was 19° (range 0°-30°). Visual analog scale pain scores averaged 0.6 (range, 0-1), visual analog scale function averaged 8.7 (range, 7-10), mean American Shoulder and Elbow Surgeons pain was 47.1 (range, 45-50), and mean American Shoulder and Elbow Surgeons function was 39.2 (range, 31-50). Subjective satisfaction ratings were excellent for four patients, and good for two, and satisfactory for one. No patients were unsatisfied with their outcomes. The horseshoe graft technique provides a reliable means for anatomic restoration of the tuberosities, facilitating the return of shoulder function in elderly patients with complex four-part proximal humerus fractures treated with a reverse total shoulder.
authors.affiliation: Holy Cross Orthopaedic Institute, Ft Lauderdale, FL 33334, USA. jonlevy123@yahoo.com
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
authors.forename: Brian
authors.initials: B
authors.lastname: Badman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D016025:Bone Transplantation; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D016348:Osseointegration; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome