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Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up

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Abstract

Purpose

Reverse shoulder arthroplasty (RSA) is often indicated in elderly patients with displaced proximal humerus fractures (PHF). The rate of greater tuberosity (GT) healing varies from 37 to 90% in this population. The aim of this study was to assess greater and lesser tuberosity (LT) fixation and healing on CT scan after RSA for PHF. Our hypothesis was that both GT and LT healing leads to better functional results after RSA for fracture.

Methods

Our retrospective cohort consisted of 28 patients treated with an RSA for a four-part PHF during the inclusion period. The mean age at surgery was 77 years. Clinical examination and CT scan were performed at a minimum one year follow-up to assess tuberosity position and healing.

Results

The GT healed in 22 patients (78.5%), the LT in 24 patients (87.5%) and both tuberosities were healed in 20 patients (71.5%). Constant score was significantly improved with GT, LT and both tuberosity healing (p = 0.05, p = 0.04 and p = 0.02 respectively). Motion in anterior elevation was improved with GT and both tuberosity healing (p = 0.01 and p = 0.04 respectively). Motion in external rotation was improved with GT and both tuberosity healing (p = 0.01 and p = 0.02 respectively).

Conclusion

GT and LT healing was associated with better functional results and active motion. Anatomical reduction and consolidation of both tuberosities is beneficial with a cumulative effect for functional recovery.

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France

    Stanislas Gunst, John Swan, Sebastien Lustig & Elvire Servien

  2. Department of Orthopaedic Surgery, Groupement Hospitalier Sud, University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France

    Lucie Louboutin

  3. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France

    Sebastien Lustig

  4. LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

  5. Centre Orthopédique Santy, Hopital Prive Jean-Mermoz, 69008, Lyon, France

    Laurent Nove-Josserand

Authors
  1. Stanislas Gunst
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  2. Lucie Louboutin
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  4. Sebastien Lustig
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  6. Laurent Nove-Josserand
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Correspondence to Stanislas Gunst.

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Conflict of interest

Stanislas Gunst, Lucie Louboutin, John Swan, Elvire Servien, Sebastien Lustig: These authors, their immediate family and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Laurent Nove-Josserand receives royalties from 3S Ortho.

Ethics approval

The CPP Sud Est ethical committee of Hospice Civils de Lyon (HCL) approved this study which complies with MR004 methodology, registered in CNIL under number 18-309. It was approved by the scientific IRB00010835 under the number COS-RGDS-2020-01-009-NOVE JOSSERAND-L Data was kept in a confidential database.

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Gunst, S., Louboutin, L., Swan, J. et al. Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up. International Orthopaedics (SICOT) 45, 681–687 (2021). https://doi.org/10.1007/s00264-020-04928-9

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  • DOI: https://doi.org/10.1007/s00264-020-04928-9

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