Grammont versus lateralizing reverse shoulder arthroplasty for proximal humerus fracture: functional and radiographic outcomes.

PURPOSE: The aim of this study is to retrospectively compare clinical and radiographic outcomes of patients treated with non-lateralizing reverse shoulder arthroplasty (RSA) and with humeral lateralizing RSA after proximal humerus fracture (PHF). METHODS: In total, 32 patients (8 men and 24 women), with a mean age of 77.4 (67-92), have been reevaluated (follow-up of 14.3 months) and divided into Grammont group (G-group-16 patients, 2 men and 14 women, mean age 82.3) and lateralizing group (L-group-16 patients, 4 men and 12 women, mean age 72.5). The dominant side was affected in 21 patients. Pain, Constant-Murley score (CMS), range of motion accurately measured with inertial sensors (SHoWlder, NCSLab®) and complications. Anatomic tuberosity healing, signs of loosening or mobilization of the implants and scapular notching (according to Sirveaux classification) have been measured on standard X-ray series (antero-posterior view in neutral, external and internal rotation; axillary view; outlet view). RESULTS: Similar CMS was recorded between the two groups (G-group: 61/100; L-group: 64/100). G-group had higher forward flexion (128° vs. 112°) and abduction (126° vs. 114°), L-group had higher external rotation in abduction (35° vs. 41°); similar internal rotation (sacrum) and rotation with elbow in adduction were measured (12° vs. 19°). No statistically significant differences emerged. Anatomic healing of the tuberosity was higher in G-group (87.5% vs. 50%); low-grade scapular notching was higher in L-group (18.25% grade 1-2 vs. 0). Anatomic healed tuberosity guaranteed highly statistically significant improved functional outcomes. No revisions of the implant were performed. CONCLUSIONS: RSA can be considered a valid solution for the treatment of PHF in elderly low-demanding population. Cuff conditions should be investigated before surgery for the indication of the adequate model.

Shoulder hemiarthroplasty for proximal humeral fractures: analysis of clinical and radiographic outcomes at midterm follow-up: a series of 51 patients.

Shoulder hemiarthroplasty has historically been the gold standard treatment for proximal humeral fractures not suitable to open reduction and internal fixation. In the last decades, reverse shoulder arthroplasty has gained more and more importance. Aim of this study is to retrospectively analyze subjective and objective outcomes of a group of consecutive patients. Fifty-one patients were evaluated with a mean follow-up of 18 months (range 12-60). For all the cases, the same surgical technique was performed in all cases. Range of motion, Constant-Murley score, ponderate Constant-Murley score, visual analog score and a patients' self-assessment scale were calculated. Anatomic tuberosities healing, stem positioning or mobilization were evaluated on postoperative X-rays and follow-up CT-scans. Statistical analysis was performed to calculate a correlation between subjective and objective results. Thirty-five patients (75%) declared to be satisfied of the operated shoulder. The mean CMS was 50 (17-91), the mean pCMS 72 (16-111). The mean forward flexion measured was 98° (40°-170°), the mean external rotation with adducted arm 22° (0°-60°), the mean internal rotation at sacrum (gluteus-T12). Four implants needed revision. Forty-seven stems were correctly positioned; 84.3% of tuberosities was anatomic or low positioned and consolidated in 74.5% of cases. Statistical analysis revealed significant correlation between CMS, pCMS, VAS and subjective satisfaction and between anatomic tuberosities healing and 3-part fractures. HA implant is a valid and reliable technique for the treatment of proximal humeral fracture. From our data, patients' satisfaction depends upon pain relief more than upon restore of function.

Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years.

BACKGROUND: Proximal humerus fractures are common injuries. Locking plates and anterograde medullary nails are the two most common fixation devices used when open reduction and internal fixation (ORIF) is indicated. Complications related to fracture and to hardware are numerous, especially shoulder stiffness. The goal of this study is to report the clinical outcomes of gleno-humeral arthroscopic arthrolysis combined with hardware removal. METHODS: A total of 58 patients (25 men, 33 women) with a mean age of 58 years (24-79) were reviewed retrospectively. Forty of them were active workers (5 heavy workers), and 18 were retired. A total of 24 fractures were reported after sport accident, 26 after domestic accident, and 8 after high energy trauma. Thirty-four patients with 3 or 4 part fractures (fracture through the anatomic neck and tuberosities), 20 patients with two part (displaced surgical neck) fracture and 4 cases of fracture of the tuberosities were operated. We combined a gleno-humeral arthrolysis by arthroscopy and a removal of the hardware using the previous incision for the plate or by arthroscopy for the nail. RESULTS: The average follow-up was 23 months (range 6-60). Pain in Constant Murley score (CS) increased from 7.3 ± 3.8 points preoperatively to 13 ± 2.76 points post-operatively (p < 0.05). CS increased from 36.8 ± 12.25 points to 68.45 ± 15.24 points. Subjective shoulder value (SSV) score increased from 45.8 ± 16.6 to 78.23 ± 14.74. A gain in all active range of motion was reported (forward flexion: 37.6°, abduction: 39.5°, external rotation: 24.3°, internal rotation: from L5-S1 to T12-L1). CONCLUSIONS: Gleno-humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.

Strength recovery after proximal humeral fractures treated with locking plate.

PURPOSE: The aim of this study is to understand whether the isokinetic strength could be a valid objective data of functional recovery evaluating a group of patients with proximal humeral fractures treated with open reduction and internal fixation with locking plate comparing the clinical and functional recovery (isokinetic strength) with the not involved side. METHODS: Seventy patients underwent surgery with locking plate placement for proximal humeral fractures. The strength of each patient's shoulders, both involved and not involved, was evaluated using isokinetic tests and Constant-Murley score. Finally, the study included 48 patients and the mean follow-up of 33 months. RESULTS: The functional outcome showed no significant differences between operated and not operated shoulder. CONCLUSIONS: This study shows that the assessment of the force can be supported by use of tools such as the evaluation with isokinetic machines with the advantage of having, in this way, an objective data on the functional recovery. LEVEL OF EVIDENCE: III.