title: Reverse shoulder arthroplasty for proximal humerus fracture using a dedicated stem: radiological outcomes at a minimum 2 years of follow-up-case series.
abstract: BACKGROUND
  Complex proximal humeral fractures are very difficult to treat particularly in patients older than 65 years with an osteoporotic bone and tuberosities compromised. The goal of this paper is to evaluate radiological outcomes at mid-term follow-up of proximal humerus fractures treated with reverse shoulder arthroplasty using a dedicated fracture stem.
  
  
  METHODS
  The study population included 98 patients who underwent reverse shoulder with a dedicated fracture stem for an acute proximal humerus fracture; 87/98 patients were available for analysis. There were 62 female and 25 male patients, and the mean age was 76.2 years at the time of surgery (range 61-90 years). Clinical and radiological outcomes were evaluated at a mean follow-up of 27 months after surgery.
  
  
  RESULTS
  Average active elevation was 137.7°, external rotation 29.1°, and internal rotation 40.7°. Overall, the tuberosity healing rate was 75 %. There was a significant increase in active anterior elevation, external rotation, and internal rotation among patients who demonstrated radiographic evidence of tuberosity healing. All tuberosity nonunions (21 cases) occurred preferentially in females, but this number did not reach statistical significance.
  
  
  CONCLUSIONS
  RSP using a dedicated stem is a very viable solution to treat complex humerus proximal fracture. Reliable restoration of elevation can be expected. However, in patients in whom tuberosity healing occurs, a better active elevation other than restoration of active rotational movement can be observed.
authors: Shoulder Service, Upper Limb Unit, F. Miulli Hospital, Km 4 strada per Santeramo, Acquaviva delle fonti, Bari, 70026, Italy. raffaelegarofalo@gmail.com.
authors: Raffaele
authors: R
authors: Garofalo
authors: The Shoulder Center, Baylor University Medical Center, Dallas, TX, USA. brody.flanagin@baylorhealth.edu.
authors: Brody
authors: B
authors: Flanagin
authors: Shoulder and Elbow Unit, IRCCS Humanitas Institute, Milan, Italy. alex.castagna@tin.it.
authors: Alessandro
authors: A
authors: Castagna
authors: San Francisco Multi-Speciality Medical Group, San Francisco, CA, USA. eddielo06@gmail.com.
authors: Eddie Y
authors: EY
authors: Lo
authors: The Shoulder Center, Baylor University Medical Center, Dallas, TX, USA. skrishnan@baylorhealth.edu.
authors: Sumant G
authors: SG
authors: Krishnan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome