MUSCULOSKELETAL SURGERY

, Volume 98, Supplement 1, pp 5–13 | Cite as

Reverse shoulder arthroplasty without subscapularis repair for the treatment of proximal humeral fractures in the elderly

Original Article
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Abstract

Purpose

The aim of this study was to evaluate the short-term results after reverse shoulder arthroplasty (RSA) for proximal humeral fractures in elderly patients.

Methods

The same surgical technique was adopted in all patients: the procedure was performed through a deltopectoral approach, the subscapularis was always resected, and a positioning jig was used to implant the cemented humeral component in the desired height and in 20° of retroversion. Nineteen consecutive patients, affected by complex fractures of the proximal humerus, were operated in a 3-year period by the same surgeon at a single institution. All the patients were female, with a mean age of 75 years (range 70–83).

Results

Fifteen patients were evaluated at an average follow-up of 22 months (range 12–46 months). A postoperative infected hematoma was the only recorded complication. The absolute Constant score averaged 45.7 (range 19–69), while the relative and normalized scores averaged 65.1 (range 33–97) and 58.5 (range 24–91), respectively. The average Shoulder Pain and Disability Index (SPADI) score was 39 (range 6–89). X-rays showed healing of the greater tuberosity to the humeral diaphysis in nine shoulders.

Conclusions

RSA is an established treatment option for elderly patients with proximal humeral fractures, particularly when general and local conditions are predictive of failure with hemiarthroplasty. Even though clinical results were quite variable in this series of patients, the adoption of a standardized surgical technique allowed to minimize postoperative complications. Subscapularis repair does not seem a critical factor for preventing implant dislocation, but its influence on functional results needs further investigation.

Keywords

Reverse shoulder arthroplasty Proximal humeral fractures Subscapularis Elderly 
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Notes

Conflict of interest

None of the authors received payments or services, either directly or indirectly (i.e., via his or her Institution), from a third party in support of any aspect of this work. Federico A. Grassi receives consulting fees from DePuy Synthes. Ilaria Zorzolo has not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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 enrollment in the study and to the inclusion in this article of information that could potentially lead to their identification.

Human and Animal Rights

The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.

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Copyright information

© Istituto Ortopedico Rizzoli 2014

Authors and Affiliations

  1. 1.S.C. Ortopedia e Traumatologia, A.O.U. “Maggiore della Carità”Università degli studi del Piemonte Orientale “A. Avogadro”NovaraItaly

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