Treatment of proximal humerus fractures using reverse shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical outcome and tuberosity healing?

INTRODUCTION: The employment of reverse shoulder arthroplasty for dislocated proximal humerus fractures of elderly patients becomes increasingly relevant. The standard inclination angle of the humeral component was 155°. Lately, there is a trend towards smaller inclination angles of 145° or 135°. Additionally, there has been an increased focus on the lateralization of the glenosphere. This retrospective comparative study evaluates clinical and radiological results of patients treated for proximal humerus fractures by reverse shoulder arthroplasty with different inclination angles of the humeral component, which was either 135° or 155°. Additionally, a different lateral offset of the glenosphere, which was either 0 mm or 4 mm, was used. METHODS: For this retrospective comparative analysis, 58 out of 66 patients treated by reverse total shoulder arthroplasty for proximal humerus fractures were included. The minimum follow-up was 24 months. Thirty (m = 3, f = 27; mean age 78 years; mean FU 35 months, range 24-58 months) were treated with a standard 155° humeral component and a glenosphere without lateral offset (group A), while 28 patients (m = 2, f = 26; mean age 79 years; mean FU 30 months, range 24-46 months) were treated with a 135° humeral component and a glenosphere with a 4 mm lateral offset (group B). We determined range of motion, Constant score, and the American Shoulder and Elbow Surgeons Shoulder score as clinical outcomes and evaluated tuberosity healing as well as scapula notching. RESULTS: Neither forward flexion (A = 128°, B = 121°; p = 0.710) nor abduction (A = 111°, B = 106°; p = 0.327) revealed differences between the groups. The mean Constant Score rated 63 in group A, while it was 61 in group B (p = 0.350). There were no differences of the ASES Score between the groups (A = 74, B = 72; p = 0.270). There was an increased risk for scapula notching in group A (47%) in comparison to group B (4%, p = 0.001). Healing of the greater tuberosity was achieved in 57% of group A and in 75% of group B (p = 0.142). The healing rate of the lesser tuberosity measured 33% in group A and 71% in group B (p = 0.004). CONCLUSIONS: Both inclination angles of the humeral component are feasible options for the treatment of proximal humerus fractures in elderly patients. Neither the inclination angle nor the lateral offset of the glenosphere seem to have a relevant influence on the clinical outcome. The healing rate of the lesser tuberosity was higher in implants with a decreased neck-shaft angle. There is an increased risk for scapula notching, if a higher inclination angle of the humeral component is chosen. LEVEL OF EVIDENCE: III. Retrospective comparative study.

Traumatic Tear of the Latissimus Dorsi Tendon in a CrossFit Athlete: Surgical Management.

INTRODUCTION: Traumatic tears of the latissimus dorsi tendon (LDT) are a rare sports injury that may occur during exercises involving horizontal and vertical pulling. A standardized treatment algorithm for this injury does not yet exist. CASE REPORT: A 30-year old male CrossFit Athlete experienced sudden unbearable pain in his right posterior shoulder during a bar muscle-up exercise. The contour of his right posterior shoulder had changed immediately, and the patient could not do any more exercises involving his right shoulder. BMagnet resonance imaging (MRI) revealed an isolated tear of the LDT. The repair of the tendon was performed using a posterior approach in the lateral decubitus position. After arming the tendon with non-absorbable sutures it was reinserted onto the crest of the lesser tuberosity of the proximal humerus with two monocortical suture buttons. Postoperatively, the patient was immobilized with an abduction pillow for 6 weeks. After 9 months he reported a 90% function of his shoulder. MRI showed complete anatomical reinsertion of the LDT. The patient was able to master 15 pull-ups in a row. CONCLUSIONS: Surgical repair of the LDT may achieve good functional results as well as an acceptable recovery period.