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Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly.

AbstractBACKGROUND:
The purpose of this study was to review the survivorship, radiologic and clinical outcomes of reverse shoulder arthroplasty (RSA) used for the treatment of 3-part and 4-part proximal humeral fractures in the elderly.
METHODS:
Between 2003 and 2009, 29 shoulders in 28 elderly patients (87% female) with a 3-part or 4-part fractures were managed with RSA in Brisbane, Australia. Clinical and radiologic outcomes of this continuous cohort were retrospectively reviewed at an average follow-up of 54.9 months. Average age at surgery was 79 years. Survivorship and radiologic outcome assessment for all patients was undertaken. Seven patients died, and 1 was unavailable for clinical review, leaving 21 shoulders in 20 patients available for clinical review.
RESULTS:
There were no revisions of the reverse prosthesis. Mean average pain was 2.19 of 100 (standard deviation [SD], 6.97). Mean American Shoulder and Elbow Surgeons score was 89.3 (SD, 13.65). Mean normalized Constant score was 88.03 (SD, 11.24). Grade 1 scapular notching was observed radiologically in 4 shoulders. A scapular spur was observed in 7 shoulders. Class 1 heterotopic ossification was seen in 4 shoulders. Nonprogressive lucent lines were seen in 2 shoulders. Nonprogressive radiolucency was observed around the superior screw in 3 shoulders. No loosening of the glenoid baseplate or of the humeral component was observed. There was 1 complication of an axillary nerve palsy, which spontaneously resolved by 12 months after surgery.
CONCLUSION:
RSA using the shoulder technique described in this series provides good clinical and radiologic outcomes in elderly patients with 3-part and 4-part fractures.
AuthorsMark Ross, Ben Hope, Andy Stokes, Susan E Peters, Iain McLeod, Phillip F R Duke
JournalJournal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 24 Issue 2 Pg. 215-22 (Feb 2015) ISSN: 1532-6500 [Electronic] United States
PMID25168347 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Topics
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement (adverse effects, methods)
  • Bone Screws
  • Female
  • Follow-Up Studies
  • Fractures, Comminuted (surgery)
  • Humans
  • Joint Prosthesis
  • Male
  • Ossification, Heterotopic (diagnostic imaging)
  • Pain Measurement
  • Pain, Postoperative (etiology)
  • Radiography
  • Retrospective Studies
  • Scapula (diagnostic imaging)
  • Shoulder (diagnostic imaging)
  • Shoulder Fractures (surgery)
  • Shoulder Joint (diagnostic imaging, surgery)
  • Survival Rate

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