title: Reverse shoulder arthroplasty as a salvage procedure after failed internal fixation of fractures of the proximal humerus: outcomes and complications.
abstract: Failed internal fixation of a fracture of the proximal humerus produces many challenges with limited surgical options. The aim of this study was to evaluate the clinical outcomes after the use of a reverse shoulder arthroplasty under these circumstances. Between 2007 and 2012, 19 patients (15 women and four men, mean age 66 years; 52 to 82) with failed internal fixation after a proximal humeral fracture, underwent implant removal and reverse shoulder arthroplasty (RSA). The mean follow-up was 36 months (25 to 60). The mean American Shoulder and Elbow Score improved from 27.8 to 50.1 (p = 0.019). The mean Simple Shoulder Test score improved from 0.7 to 3.2 (p = 0.020), and the mean visual analogue scale for pain improved from 6.8 to 4.3 (p = 0.012). Mean forward flexion improved from 58.7° to 101.1° (p < 0.001), mean abduction from 58.7° to 89.1° (p = 0.012), mean external rotation from 10.7° to 23.1° (p = 0.043) and mean internal rotation from buttocks to L4 (p = 0.034). A major complication was recorded in five patients (26%) (one intra-operative fracture, loosening of the humeral component in two and two peri-prosthetic fractures). A total of 15 patients (79%) rated their outcome as excellent or good, one (5%) as satisfactory, and three (16%) as unsatisfactory. An improvement in outcomes and pain can be expected when performing a RSA as a salvage procedure after failed internal fixation of a fracture of the proximal humerus. Patients should be cautioned about the possibility for major complications following this technically demanding procedure.
authors.affiliation: Arkansas Specialty Orthopaedics, 600 S McKinley, Little Rock, Arkansas, 72205, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Hussey
authors.affiliation: The University of South Florida, 4202 E Fowler Ave, Tampa, Florida 33620, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Hussey
authors.affiliation: Florida Orthopaedic Institute, 13020 Telecom Dr, Tampa, Florida 33637, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Mighell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016879:Salvage Therapy; D012784:Shoulder Fractures / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Arthroplasty; Failed; Fixation; Fractures; Humerus; Internal; Proximal; Reverse