Brisbane Hand & Upper Limb


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

Ross M, Hope B, Stokes A, Peters SE, McLeod I, and Duke PFR.
Journal of Shoulder and Elbow Surgery 2014; 24(2): 215-222.
DOI: 10.1016/j.jse.2014.05.022

Background: 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.


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The Brisbane Hand and Upper Limb Research Institute was established in 2010 to facilitate and coordinate upper limb clinical and basic science research across the private and public sector in Brisbane, Queensland Australia.