title: Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty?
abstract: BACKGROUND
  Functional outcomes of reverse total shoulder arthroplasty (rTSA) can be improved by fixation of the tuberosities. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures treated with rTSA, with and without autologous grafting.
  
  
  METHODS
  Thirty-three patients with proximal humeral fractures were treated with rTSA and tuberosity fixation. In 18 patients (group I; mean age, 75 years), tuberosity fixation was augmented with autografting; in 15 patients (group II; mean age, 71 years), graft augmentation was not used. The mean follow-up was 16.7 (range, 12-24) months in group I and 16.8 (range, 12-25) months in group II.
  
  
  RESULTS
  Radiologic tuberosity union was achieved in 14 of 18 (77.8%) patients who underwent autograft augmentation and in 6 of 15 (40.0%) patients treated without autografting. The mean American Shoulder and Elbow Surgeons (ASES) score was 69.6 ± 13.0 in group I and 51.0 ± 20.0 in group II. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 31.9 ± 24.0 in group I and 58.2 ± 24.6 in group II. A significant difference was detected between groups for ASES and DASH scores. Among shoulder range of motion measures, only forward flexion differed significantly between groups I and II (124° ± 23° vs. 98° ± 30°, respectively). External rotation muscle strength was significantly higher in group I (3.36 ± 1.46 kg) than in group II (2.39 ± 2.00 kg).
  
  
  CONCLUSIONS
  In the treatment of complex proximal humeral fractures in elderly patients by rTSA, cancellous block autograft augmentation can increase the rate of tuberosity union and improve functional outcomes.
authors: Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
authors: Gokcer
authors: G
authors: Uzer
authors: Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
authors: Fatih
authors: F
authors: Yildiz
authors: Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
authors: Suat
authors: S
authors: Batar
authors: Department of Orthopedics and Traumatology, Binzeela Modern Hospital, Sieyun, Hadramout, Yemen.
authors: Ruwais
authors: R
authors: Binlaksar
authors: Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
authors: Mehmet
authors: M
authors: Elmadag
authors: Faculty of Health Science, Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey.
authors: Gamze
authors: G
authors: Kus
authors: Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey. Electronic address: kbilsel@gmail.com.
authors: Kerem
authors: K
authors: Bilsel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D016025:Bone Transplantation; D005260:Female; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Three-four parts proximal humeral fracture; autografting; graft; reverse total shoulder arthroplasty; tuberosity fixation; tuberosity healing