title: The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty.
abstract: BACKGROUND
  Experience with treating proximal humeral nonunions with reverse total shoulder arthroplasty is limited. We report our results.
  
  
  METHODS
  Eighteen patients with proximal humeral atrophic nonunion were treated with reverse total shoulder prosthesis. There were 12 women and 6 men, with a mean age of 78.8 years (range, 75-84 years). The mean follow up after reverse arthroplasty was 28 months (range, 24-32 months). Extensive proximal humeral bone loss that was found in six cases was treated adding a proximal humeral allograft. A long humeral stem was always used.
  
  
  RESULTS
  The mean Constant score increased from 26% preoperatively to 55% postoperatively (p <0.0001). The average anterior elevation increased from 35° to 90° (p<0.0001), abduction from 35° to 85° (p<0.0001), external rotation from 15° to 30° (p <0.0001) and internal rotation from 25° to 55° (p <0.0001). The average subjective shoulder score increased from 10% preoperatively to 50% postoperatively (p <0.0001). All but 4 patients would undergo the same procedure again if faced with the same problem. Eight patients were very satisfied, 6 satisfied and 4 unhappy with the operation. We had one case of transitory axillary nerve palsy and two cases of infection. Two prosthetic dislocations occurred; they were successfully treated by revision with a larger polyethylene glenosphere of 44 mm.
  
  
  CONCLUSIONS
  Reverse total shoulder arthroplasty improves function and motion in patients with proximal humeral fracture sequelae. However, the rate of dislocation is high.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Angel A
authors.initials: AA
authors.lastname: Martinez
authors.forename: Carlos
authors.initials: C
authors.lastname: Bejarano
authors.forename: Ignacio
authors.initials: I
authors.lastname: Carbonel
authors.forename: Daniel
authors.initials: D
authors.lastname: Iglesias
authors.forename: Jorge
authors.initials: J
authors.lastname: Gil-Albarova
authors.forename: Antonio
authors.initials: A
authors.lastname: Herrera
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D010024:Osteoporosis; D056888:Patient Positioning; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D012784:Shoulder Fractures / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome