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Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis

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The treatment of complex humeral fractures or fracture-dislocations presents several challenges. Late complications such as malunion, avascular necrosis, or nonunion are frequent and often lead to articular incongruence. Patients can be severely handicapped, presenting with considerable pain, stiffness, and important functional impairment. Stiff shoulders with distorted proximal humerus, soft tissue damage, a scarred deltoid, and rotator cuff tears make shoulder arthroplasty a challenging procedure, often with unpredictable results and a high risk of complications. The overall results of patients with old trauma are inferior to the results currently obtained in patients with primary osteoarthritis or with recent 4-part fractures who are treated initially with humeral head replacement. In certain circumstances, with important distortion of the proximal humerus, poor bone quality, rotator cuff lesions, or muscle atrophy a reverse shoulder arthroplasty can be proposed in elderly patients instead of a non-constrained arthroplasty.

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  1. Boileau P, Trojani C, Walch G, Krishnan SG, Romeo A, Sinnerton R (2001) Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Should Elbow Surg 10:299–308. doi:10.1067/mse.2001.115985

    Article  CAS  Google Scholar 

  2. Moineau G, McClelland WB, Trojano C, Rumian A, Walch G, Boileau P (2012) Prognostic factors and limitations of anatomic shoulder arthroplasty for the treatment of posttraumatic cephalic collapse or necrosis (Type-1 proximal humeral fracture sequelae). J Bone Joint Surg Am 94:2186–2194. doi:10.2106/JBJS.J.00412

    Article  PubMed  Google Scholar 

  3. Mansat P (2006) Les séquelles traumatiques ostéo-articulaires de l’articulation gléno-humérale. Sauramps Médical, Montpellier

    Google Scholar 

  4. Boileau P, Chuinard C, Le Huec J-C, Walh G, Trojani C (2006) Proximal humeral fracture sequelae. Impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res 442:121–130. doi:10.1097/01.blo.0000195679.87258.6e

    Article  PubMed  Google Scholar 

  5. Boileau P, Neyton L (2008) Reverse shoulder arthroplasty in proximal humerus fracture sequelae. Constrained or nonconstrained prosthesis? In “Shoulder Concepts 2008 – Proximal humeral fractures and fracture sequelae”, under the direction of P Boileau, G Walch, D Molé, L Favard, C Lévigne, F Sirveaux and JF Kempf, Sauramps Médical, pp 265–269.

  6. Castagna A, Delcogliano M, de Caro F, Ziveri G, Borroni M, Gumina S, Postacchini F, De Biase CF (2013) Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system. Int Orthop 37:1297–1305. doi:10.1007/s00264-013-1907-4

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ortmaier R, Resch H, Matis N, Blocher M, Auffarth A, Mayer M, Hitzl W, Tauber M (2013) Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty – outcome and follow-up. Int Orthop 37:67–75. doi:10.1007/s00264-012-1742-z

    Article  PubMed Central  PubMed  Google Scholar 

  8. Scarlat MM (2013) Complications with reverse total shoulder arthroplasty and recent evolutions. Int Orthop 37:843–851. doi:10.1007/s00264-013-1832-6

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kilic M, Berth A, Blatter G, Fuhrmann U, Gebhardt K, Rott O, Zenz P, Irlenbusch U (2010) Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral head. Acta Orthop Traumatol Turc 44:417–425. doi:10.3944/AOTT.2010.2272

    Article  PubMed  Google Scholar 

  10. Alentorn-Geli E, Guirro P, Santana F, Torrens C (2014) Treatment of fracture sequelae of the proximal humerus: comparison of hémiarthroplastie and reverse total shoulder arthroplasty. Arch Orthop Trauma Surg 134:1545–1550. doi:10.1007/s00402-014-2074-9

    Article  PubMed  Google Scholar 

  11. Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89:1476–1485

    Article  PubMed  Google Scholar 

  12. Wellmann M, Struck M, Pastor MF, Gettmann A, Windhagen H, Smith T (2013) Short and mid-term results of reverse shoulder arthroplasty according to the preoperative etiology. Arch Orthop Trauma Surg 133:463–471. doi:10.1007/s00402-013-1688-7

    Article  PubMed  Google Scholar 

  13. Fevang BT, Lygre SHL, Bertelsen G, Skredderstuen A, Havelin LI, Furnes O (2013) Pain and function in eight hundred and fifty nine patients comparing hemiprostheses, resurfacing prostheses, reversed total and conventional total prostheses. Intern Orthop 37:59–66. doi:10.1007/s00264-012-1722-3

  14. Willis M, Min W, Brooks JP, Mulieri P, Walker M, Pupello D, Frankle M (2012) Proximal humeral malunion treated with reverse shoulder arthroplasty. J Should Elbow Surg 21:507–513. doi:10.1016/j.jse.2011.01.042

    Article  Google Scholar 

  15. Martinez AA, Bejarano C, Carbonel I, Iglesias D, Gil-Albarova J, Herrera A (2012) The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty. Injury 43:S3–S6. doi:10.1016/j.injury.2011.12.015

    Article  PubMed  Google Scholar 

  16. Martinez AA, Calvo A, Bejarano C, Carbonel I, Herrera A (2012) The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus. J Orthop Sci 17:141–147. doi:10.1007/s00776-011-0185-5

    Article  PubMed  Google Scholar 

  17. Zafra M, Uceda P, Flores M, Carpintero P (2014) Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus. Bone Joint J 96:1239–1243. doi:10.1302/0301-620X.96B9

    Article  PubMed  Google Scholar 

  18. Neer CS II, Watson KC, Stanton FJ (1982) Recent experience in total shoulder replacement. J Bone Joint Surg Am 64:319–337

    PubMed  Google Scholar 

  19. Tanner MW, Cofield RH (1983) Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res 179:116–128

    Article  PubMed  Google Scholar 

  20. Huten D, Duparc J (1986) L’arthroplastie totale de l’épaule dans les traumatismes complexes récents et anciens de l’épaule. Rev Chir Orthop 72:517–529

    CAS  PubMed  Google Scholar 

  21. Frich LH, Sojbjerg JO, Sneppen O (1991) Shoulder arthroplasty in complex acute and chronic proximal humeral fractures. Orthopedics 9:949–954

    Google Scholar 

  22. Habermeyer P, Schweiberer L (1992) Corrective interventions subsequent to humeral head fractures. Orthopade 21:148–157

    CAS  PubMed  Google Scholar 

  23. Dines DM, Warren RF, Altchek DW, Moeckel B (1993) Posttraumatic changes of the proximal humerus: malunion, nonunion, and osteonecrosis. Treatment with modular hemiarthroplasty or total shoulder arthroplasty. J Should Elbow Surg 2:11–21

    Article  CAS  Google Scholar 

  24. Norris TR, Green A, McGuigan FX (1995) Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures. J Should Elbow Surg 4:271–280

    Article  CAS  Google Scholar 

  25. Postel JM, Tamames M, Lenoble E, Goutallier D (1995) Les arthroses post-traumatiques. Rev Chir Orthop II:111–115

    Google Scholar 

  26. Bosch U, Skutek M, Fremerey RW, Tscherne H (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Should Elbow Surg 7:479–484

    Article  CAS  Google Scholar 

  27. Beredjiklian PK, Iannotti JP, Norris TR, Williams GR (1998) Operative treatment of malunion of a fracture of the proximal aspect of the humerus. J Bone Joint Surg Am 80:1484–1497

    CAS  PubMed  Google Scholar 

  28. Antuna S, Sperling JW, Sanchez-Sotelo J, Cofield RH (2002) Shoulder arthroplasty for proximal humeral malunions: long-term results. J Should Elbow Surg 11:122–129. doi:10.1067/mse.2002.120913

    Article  Google Scholar 

  29. Mansat P, Guity MR, Bellumore Y, Mansat M (2004) Shoulder arthroplasty for late sequelae of proximal humeral head fractures. J Should Elbow Surg 13:305–312. doi:10.1016/j.jse.2004.01.020

    Article  Google Scholar 

  30. Lin JS, Klepps S, Miller S, Cleeman E, Flatow EL (2006) Effectiveness of replacement arthroplasty with calcar grafting and avoidance of greater tuberosity osteotomy for the treatment of humeral surgical neck nonunions. J Should Elbow Surg 15:12–18. doi:10.1016/j.jse.2005.04.010

    Article  Google Scholar 

  31. Duquin TR, Jacobson JA, Sanchez-Sotelo J, Sperling JW, Cofield RH (2012) Unconstrained shoulder arthroplasty for treatment of proximal humeral nonunions. J Bone Joint Surg Am 94:1610–1617. doi:10.2106/JBJS.J.01975

    Article  PubMed  Google Scholar 

  32. Jacobson JA, Duquin TR, Sanchez-Sotelo J, Schleck CD, Sperling JW, Cofield RH (2014) Anatomic shoulder arthroplasty for treatment of proximal humerus malunions. J Sould Elbow Surg 23:1232–1239. doi:10.1016/j.jse.2013.11.015

    Article  Google Scholar 

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Correspondence to Pierre Mansat.

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Mansat, P., Bonnevialle, N. Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis. International Orthopaedics (SICOT) 39, 349–354 (2015).

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