Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty.
OBJECTIVE
Reverse shoulder arthroplasty in complex shoulder fractures is now a common practice. Unfortunately, loss of rotation is observed when tuberosity excision is used, impairing function and patient satisfaction. The purpose of this study was to evaluate the advantage of tuberosity repair in terms of the functional result.


METHODS
We reviewed 41 patients, with a mean age at trauma of 76.9 years, at a mean follow-up of 24 months. Tuberosities were repaired in 27 patients and totally removed in the other 14 cases.


RESULTS
Two-thirds of the repaired tuberosities consolidated in anatomic position. We compared a group with tuberosity healing in anatomic position versus a group without repair and with malunion or nonunion of the tuberosities. In the first group, all sectors of motion, especially external rotation (49° vs 10°), were improved and both Constant scores (65 vs 50) and Disabilities of the Arm, Shoulder and Hand scores (30 vs 40) were significantly better.


CONCLUSIONS
Management of complex fractures of the superior extremity of the humerus by reverse shoulder arthroplasty is an accepted approach, but such treatment is restricted to elderly patients. Shoulder rotational ability is improved by systematically repairing the tuberosities around the implant. However, their consolidation should be anatomic; otherwise, the result is impaired by the lack of rotation. Nonunion or malunion does not lead to a functional disaster, as is sometimes the case with hemiarthroplasty without tuberosity healing.
Saint Vincent Private Hospital, 33 Chemin des Tilleroyes, Besançon, France. contact@docteurgallinet.com
David
D
Gallinet
Antoine
A
Adam
Nicolas
N
Gasse
Severin
S
Rochet
Laurent
L
Obert
D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D012784:Shoulder Fractures / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome