title: Four-part fractures treated with a reversed total shoulder prosthesis: Prospective and retrospective multicenter study. Results and complications.
abstract: The reversed shoulder prosthesis is becoming the gold standard for cases of complex fracture of the proximal humerus after 70 years of age.
  
  
  
  The French Society of Orthopaedic and Traumatology Surgery (SOFCOT) conducted a prospective and retrospective multicenter study to evaluate the results of the reversed shoulder prosthesis implanted in patients with a four-part fracture in nine centers. In the retrospective study (n=41 patients, 78 years of age, 14% ASA grade 3, 21% associated fractures) and in the prospective study (n=32 patients, 79 years of age, 37% ASA grade 3, 21% associated fractures) evaluation by independent surgeons was conducted to measure the QuickDASH score, the Constant score, the SSV (subjective shoulder value), and complications to correlate these measurements with radiological results.
  
  
  
  In both studies, use of an autograft (75%) to perform an osteosuture of tuberosities (90%) and no postoperative immobilization (75%) were similar. In the retrospective study at 39 months (range: 24-62 months) of follow-up, the QuickDASH reached 28 (range: 0-59), the Constant scores (raw Constant=57, weighted Constant=83.4%), and SSV 75 (range: 35-100). Complications after the 1st month (7%) were nonunion or ossifications. In the prospective study at 11 months (range: 5-16.5 months) of follow-up, the QuickDASH reached 40 (range: 1-75), the Constant scores 50 (raw Constant) and 74.6% (weighted Constant), and SSV 69 (range: 10-100). Complications after the 1st month (21%) were stiffness and dislocation, with two patients who underwent revision surgery. In both studies, early complications reached 6% (palsy, dislocation).
  
  
  
  This double (retrospective and prospective) study confirms the good results with a low level of complications of the reversed implant in cases of fracture but with osteosuture of tuberosities.
authors.affiliation: Chirurgie orthopédique, traumatologique et plastique, centre hospitalier de Besançon, 2, boulevard Fleming, 25030 Besançon, France. Electronic address: lobert@chu-besancon.fr.
authors.forename: L
authors.initials: L
authors.lastname: Obert
authors.affiliation: Chirurgie orthopédique, traumatologique et plastique, centre hospitalier de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: R
authors.initials: R
authors.lastname: Saadnia
authors.affiliation: Service d'orthopédie-traumatologie, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Tournier
authors.affiliation: Centre hospitalier universitaire de Toulouse, Institut de l'appareil locomoteur, place du Dr-Baylac, 31059, Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Bonnevialle
authors.affiliation: Service d'orthopédie-traumatologie, CHRU de Grenoble, 38000 Grenoble, France.
authors.forename: D
authors.initials: D
authors.lastname: Saragaglia
authors.affiliation: Service d'orthopédie-traumatologie, centre chirurgical E.-Galle, 49, rue Hermite, 54000 Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Sirveaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D000072227:Shoulder Prosthesis; D016896:Treatment Outcome
keywords: Elderly patients; Four-part fracture; Fractures; Multicenter study; Osteosuture; Proximal humerus; Reversed prosthesis