title: Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae).
abstract: BACKGROUND
  Fracture sequelae of the proximal part of the humerus are challenging conditions, and various treatment options have been described. The purpose of this multicenter study was to analyze the clinical and radiographic outcomes as well as the complications following semiconstrained reverse total shoulder arthroplasty for the treatment of nonunion of a surgical neck fracture of the proximal part of the humerus.
  
  
  METHODS
  Thirty-two patients with a mean age of sixty-eight years (range, forty-eight to eighty-three years) managed with a reverse shoulder arthroplasty for the treatment of nonunion of a proximal humeral fracture were analyzed clinically and radiographically. The mean duration of follow-up was four years (range, two to twelve years). The Constant score, active shoulder mobility, all complications, and revision procedures were recorded.
  
  
  RESULTS
  The mean Constant score increased from 14.2 points (range, 2 to 35 points) to 46.6 points (range, 6 to 75 points) (p < 0.001). The mean shoulder flexion increased from 42.9° (range, 0° to 160°) to 109.7° (range, 0° to 170°) (p < 0.001), and the mean external rotation increased from 0.5° (range, -40° to 60°) to 13.1° (range, -30° to 60°) (p < 0.005). No component loosening occurred, but 50% (sixteen) of the patients had radiographic evidence of scapular notching. There were thirteen complications (41%) leading to nine revision surgical procedures (28%). The most common complication was a dislocation following reverse shoulder arthroplasty, which occurred in 34% (eleven) of the patients. An intraoperative resection of the humeral head fragment and the tuberosities was associated with increased risk of dislocation (p < 0.007).
  
  
  CONCLUSIONS
  Nonunions of the proximal part of the humerus can be treated with reverse shoulder arthroplasty. Although clinical outcomes improved significantly, we found an unacceptably high rate of dislocations associated with intraoperative resection of the tuberosities. The tuberosities and the attached rotator cuff should be preserved if possible to reduce the risk of dislocation after reverse total shoulder arthroplasty.
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Universität Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Raiss
authors.affiliation: Fondren Orthopedic Group, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030.
authors.forename: T Bradley
authors.initials: TB
authors.lastname: Edwards
authors.affiliation: Orthopaedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro 1, 4200 Porto, Portugal.
authors.forename: Manuel Ribeiro
authors.initials: MR
authors.lastname: da Silva
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Bismarckstrasse 9-15, 69115 Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Loew
authors.affiliation: Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France. E-mail address: Walch.Gilles@wanadoo.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012784:Shoulder Fractures / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome