Grammont versus lateralizing reverse shoulder arthroplasty for proximal humerus fracture: functional and radiographic outcomes
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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).
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).
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.
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.
KeywordsProximal humerus Shoulder Fracture Reverse Arthroplasty Lateralizing
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
According to Italian law, the ethical approval for this study was not required because it involved only a clinical routine follow-up and a radiographic examination.
We obtained a written informed consent directly from the patient. With this approval, the patient authorizes the surgical treatment and also the collection and publication of clinical data about his case for scientific and educational purposes even outside the institution.
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