Reverse shoulder arthroplasty with glenoid bone grafting for anterior glenoid rim fracture associated with glenohumeral dislocation and proximal humerus fracture.
Large fractures of the anterior glenoid rim can result in persisting instability and osteoarthritis of the glenohumeral joint When this fracture is associated with a glenohumeral dislocation and proximal humerus fracture could be a concern. The goal of this paper was to evaluate the clinical and radiological outcomes and complications of reverse shoulder arthroplasty (RSA) and glenoid bone graft in cases with a significant anterior glenoid fracture associated with a proximal humerus fracture.



RSA and step bone graft harvested from proximal humeral head could be a viable option in the treatment of this complex injury.



Retrospective case series.



Twenty-six patients underwent RSA and glenoid bone graft in a single stage procedure were evaluated at an average 32 months postoperatively. There were 18 women and 8 men with a mean age of 68.5 years (range 63-75 years). Reverse shoulder arthroplasty with a contoured glenoid bone graft placed underneath the baseplate using humeral head autograft was utilized in all cases. Clinical outcomes were evaluated with range of motion, Constant score and self-reported subjective outcome rated as excellent, good, fair or poor. Radiographic evaluation was performed to evaluate for baseplate displacement or loosening, bone graft union, resorption or collapse.



At final follow-up, average active elevation was 135° (range 110°-145°), abduction 122° (range 60°-160°), and external rotation 30° (range 0 to 45°). The mean Constant score was 68.2 (range 54-83). The clinical results were rated as excellent by 15 patients, good by 9, and fair by 2. Radiographic evaluation showed the disc of cancellous bone graft healed without any signs of graft resorption or migration in all 26 cases. No reoperation was performed on any patient in this series.



RSA with glenoid bone grafting produces satisfactory short-term outcomes with acceptable complication rates for treatment of patients greater than 60 years old with proximal humerus fractures associated with an anterior glenoid rim fracture. Further studies are necessary to determine the extended viability of this procedure.



III.
Shoulder Service, F. Miulli Hospital, Acquaviva delle fonti, Km 4 strada per Santeramo, 70026 BA, Italy. Electronic address: raffaelegarofalo@gmail.com.
R
R
Garofalo
The Shoulder Center Baylor, University Medical Center, Dallas, USA.
F
F
Brody
Shoulder and Elbow Unit IRCCS, Humanitas Institute, Milan, Italy.
A
A
Castagna
Shoulder and Elbow Unit IRCCS, Humanitas Institute, Milan, Italy.
E
E
Ceccarelli
The Shoulder Center Baylor, University Medical Center, Dallas, USA.
S G
SG
Krishnan
D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D058430:Humeral Head / Q000637:transplantation*; D057072:Intra-Articular Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012540:Scapula / Q000293:injuries / Q000601:surgery*; D012783:Shoulder Dislocation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012784:Shoulder Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery; D014182:Transplantation, Autologous
Bone graft; Dislocation; Fracture; Glenoid; Reverse; Shoulder arthroplasty