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Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis

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Abstract

Purpose

The use of reverse shoulder arthroplasty (RSA) to treat complex humerus fractures is increasing, especially in older, osteoporotic patients. Refixation and tuberosity healing are needed to achieve an optimal range of motion (ROM), external rotation, active forward elevation, and patient satisfaction. Proper healing has been reported, however, in only 40–84% of cases. Our study’s aim was to describe a simple, reproducible fixation technique designed to improve tuberosity healing.

Methods

We included 30 patients with acute proximal humerus fractures undergoing RSA (Global Unite Reverse Fracture, DePuy Synthes, Warsaw, IN, USA) with tuberosity reattachment. The humerus stem was cemented in 24 cases. A standardized suture technique with two fiber tapes was used to reattach tuberosities. Clinical and radiological parameters, which were collected one year post-operatively, included ROM, pain level, Constant scores, subjective shoulder value (SSV), and tuberosity healing.

Results

The mean age of the patients was 79.3 years (± 7; range 65–92), and the tuberosity healing rate was 90.0% (27 of 30). Two patients showed migration (one nonunion, one malunion), and another had complete resorption after an initial period of proper healing. Radiolucent lines around the humerus stem occurred in one case, and three patients had scapular notching. The mean SSV was 86% (± 11; range 60–100), the Constant score was 72 (± 10.3; range 48–92), the active forward flexion was 140° (± 14.3; range 115–165), and external rotation was 23° (± 16.5; range 0–50).

Conclusions

This reattachment technique, which is simple and reproducible, achieved a higher tuberosity healing rate than previously published rates.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Florian Hess, Laurenz Jaberg, JoEllen Welter & Andrea Sireus

  2. Department of Orthopedic Surgery, Cantonal Hospital Lucerne, Sursee, Switzerland

    Laurent Bohnert

  3. Department of Trauma Surgery, University of Zurich, Zurich, Switzerland

    Hans-Christoph Pape

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  1. Florian Hess
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Correspondence to Florian Hess.

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The study design was approved by the local ethics committee (2019–00414), and written consent was obtained from all participants.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individuals described in this case series.

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Hess, F., Bohnert, L., Jaberg, L. et al. Tuberosity union in patients with proximal humerus fractures treated with reverse shoulder arthroplasty: a technical note and exploratory analysis. International Orthopaedics (SICOT) 44, 2711–2717 (2020). https://doi.org/10.1007/s00264-020-04831-3

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