Abstract
Purpose
To compare functional and radiographic results of reverse prosthesis versus hemiarthroplasty after complex displaced proximal humeral fractures in elderly patients when adequate ORIF cannot be achieved and prosthetic shoulder replacement is required.
Methods
From 2008 to 2012, 67 patients were treated with hemiarthroplasty or reverse arthroplasty. We evaluated 53 cases with an average follow-up of 27.5 months (range 12–64). Twenty-eight patients with an average age of 71.4 years were treated with a hemiarthroplasty and 25 patients with an average age of 77.3 years with a reverse prosthesis. All patients were assessed before and after surgery by Constant–ASES–DASH score, strength in abduction, ER1, ER2, and X-rays.
Results
In hemiarthroplasty group, we observed a mean Constant score of 42.3 pt, ASES score 51.3 pt, and DASH score 46.1, with an average strength of 1.3 lb in abduction and of 3.7 lb in ER1 and 1.8 lb in ER2. In reverse arthroplasty group, we measured a mean Constant of 56.2 pt, ASES 69.3 pt, and DASH score 40.4, with an average strength of 4.3 lb in abduction and of 3.3 lb in ER1 and 3.2 lb in ER2. Radiographically, it is interesting to observe that greater tuberosity healing rate was 37 % in hemiarthroplasty group compared to 84 % in reverse arthroplasty group. About complications, the highest rate was recorded in the hemiarthroplasty group.
Conclusion
Reverse shoulder arthroplasty indication is steadily increasing in acute displaced proximal humeral fracture. Pain and articular movement results appear better than those with hemiarthroplasty. Our data are similar to the international literature.
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References
Warner JJP, Costouros JC, Gerber C (2006) Fratture dell’epifisi prossimale dell’omero. Traumatologia dell’adulto, vol.2. Cap.31. Rockwood and Green
Jakob RP, Kristiansen T, Mayo K et al (1984) Classification and aspects of treatment of fractures of the proximal humerus. BC Decker, Philadelphia
Rose SH, Melton LJ, Morey BF et al (1982) Epidemiologic features of humeral fractures. Clin Orthop 168:24–30
Min W, Davidovitch RI, Tejwani NC et al (2012) Three- and four-part proximal humerus fractures evolution to operative care. Bull NYU Hosp Jt Dis 70(1):25–34
Jobin CM, Galatza LM (2012) Proximal humerus fractures: pin, plate, or replace. Semin Arthro 23:74–82
Mauro CS (2011) Proximal humeral fractures. Curr Rev Musculoskelet Med 4:214–220
Sirveaux F, Roche O, Molé D (2010) Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 96:683–694
Paavolainen P, Björkenheim JM, Slätis P et al (1983) Operative treatment of severe proximal humeral fractures. Acta Orthop Scand 54(3):374–379
Olivier H, Largier A, Lajoie D et al (1981) Les fractures de l’extrémité supérieure de l’humérus. In: Cahier d’enseignement de la SOFCOT no 13. Paris: Exp Scientifique Francaise, pp 117–28
Fenichel I, Oran A, Burstein G et al (2006) Percutaneous pinning using threaded pins as a treatment option for unstable two- and three-part fractures of the proximal humerus: a retrospective study. Int Orthop (SICOT) 30:153–157
Solberg BD, Moon CN, Franco DP (2009) Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma 23(2):113–119
Bastian JD, Hertel R (2009) Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Should Elb Surg 18:216–219
Adedapo AO, Ikpeme JO (2001) The results of internal fixation of three and four part proximal humeral fractures with the Polarus nail. Injury 32:115–121
Gerber C, Schneeberger AG, Vinh TS (1990) The arterial vascularization of the humeral head. An anatomical study. J Bone Joint Surg Am 72:1486–1494
Duparc F, Muller JM, Freger P (2001) Arterial blood supply of the proximal humeral epiphysis. Surg Radiol Anat 23:185–190
Meyer C, Alt V, Hassanin H et al (2005) The arteries of the humeral head and their relevance in fracture treatment. Surg Radiol Anat 27:232–237
Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Should Elb Surg 7:586–590
Brooks CH, Revell WJ, Heatley FW (1993) Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study. J Bone Joint Surg Br 75(1):132–136
Hertel R, Hempfing A, Stiehler M et al (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Should Elb Surg 13(4):427–433
Jakob RP, Miniaci A, Anson PS et al (1991) Four-part valgus-impacted fractures of the proximal humerus. J Bone Joint Surg Br 73:295–298
Babhulkar A, Shyam AK, Sancheti PK (2011) Hemiarthroplasty for comminuted proximal humeral fractures. J Orthop Surg 19(2):194–199
Castricini R, De Benedetto M, Pirani P et al (2011) Shoulder hemiarthroplasty for fractures of the proximal humerus. Musculoskelet Surg 95(Suppl 1):S49–S54
Sirveaux F, Navez G, Favard L et al (2006) Reverse prosthesis for acute proximal humerus fractures, the multicentric study. Nice shoulder course 2006, Arthroscopy and arthroplasty: current concepts, 1–3 June 2006
Walch G, Wall B (2006) Synthesis: indications and techniques of revision arthroplasty with a reverse prosthesis. Nice shoulder course 2006, Arthroscopy and arthroplasty: current concepts, 1–3 June 2006
Molè D, Navez G, Garaud P (2006) Reverse shoulder prosthesis: problems related to the glenoid. Nice shoulder course 2006, Arthroscopy and arthroplasty: current concepts 1–3 June 2006
Solberg BD, Moon CN, Franco DP et al (2009) Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma 23(2):113–119
Bastian JD, Hertel R (2009) Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Should Elb Surg 18:216–219
Hurd JL, Zuckerman JD (2009) What is the best treatment for complex proximal humerus fractures? What are the main determinants of outcome after arthroplasty? Chapter 20. Upper extremity topics. Evidence-based orthopaedics
Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16:S65–S72
Gronhagen CM, Abbaszadegan H, Revay S et al (2007) Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Should Elb Surg 16(6):766–773
Noyes MP, Kleinhenz B, Markert R et al (2011) Functional and radiographic long-term outcomes of hemiarthroplasty for proximal humeral fractures. J Should Elb Surg 20:372–377
Reuther F, Muhlhausler B, Wahl D et al (2010) Functional outcome of shoulder hemiarthroplasty for fractures: a multicentre analysis. Injury Int J Care Inj 41:606–612
Kralinger F, Schwaiger R, Wambacher M et al (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. J Bone Joint Surg Br 86(2):217–219
Wretenberg P, Ekelund A (1997) Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed for 2–7 years. Acta Orthop Scand 68:121–123
Valenti PH, Boutsen D, Nerot C (2001) Delta III reversed prosthesis for osteoarthritis with massive rotator cuff tear: long-term results (>5 years). In: Walch G, Boileau P, Mole P (eds) Shoulder prosthesis: two to ten year follow-up. Sauramps Medical, Montepellier, France, pp 253–259
Favard L, Sirveaux F, Bicknell R et al (2006) The multicenter study: methodology and presentation. Nice shoulder course 2006. Arthroscopy and arthroplasty: current concepts, 1–3 June 2006
Cazeneuve JF, Hassan Y, Kermad F et al (2008) Delta III reverse-ball-and-socket total shoulder prosthesis for acute complex fractures of the proximal humerus in elderly population. Eur J Orthop Surg Traumatol 18:81–86
Klein M, Juschka M, Hinkenjann B (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the delta III reverse shoulder prosthesis. J Orthop Trauma 22:698–704
Macitti T, Leone P, Piscitello S (2011) L’Artroprotesi inversa nel trattamento delle fratture a 3–4 frammenti dell’estremo prossimale dell’omero dell’anziano AITOG OGGI—settembre
Sirveaux F, Favard L, Oudet D et al (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicenter study of 80 shoulders. J Bone Joint Surg Br 86:388–395
Young SW, Segal BS, Turner PC et al (2010) Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. ANZ J Surg 80(11):789–793
Gallinet D, Clappaz P, Garbuio P et al (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95:48–55
Aldegheri R, Iacobellis C (2009) La sostituzione protesica nelle fratture prossimali d’omero nell’anziano. GIOT 35:6–15
Gallinet D, Adam A, Gasse N et al (2013) Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Should Elb Surg 22:38–44
Garrigues GE, Johnston PS, Pepe MD et al (2013) Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics 35(5):e703–e708
Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg 95:2050–2055
Conflict of interest
P. Baudi, G. Campochiaro, F. Serafini, G. Gazzotti, G. Matino, C. Rovesta, F. Catani declare that they have no conflict of interest.
Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.
Human & Animal Studies
The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.
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Baudi, P., Campochiaro, G., Serafini, F. et al. Hemiarthroplasty versus reverse shoulder arthroplasty: comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture. Musculoskelet Surg 98 (Suppl 1), 19–25 (2014). https://doi.org/10.1007/s12306-014-0322-3
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DOI: https://doi.org/10.1007/s12306-014-0322-3