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Is malunion of the greater tuberosity after reverse shoulder arthroplasty in patients with complex proximal humerus fracture associated with worse clinical outcomes? A prospective cohort study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To assess patient outcomes following reverse shoulder arthroplasty in patients with complex proximal humerus fracture and the clinical implications of greater tuberosity malunions.

Methods

This prospective study included 56 patients who underwent RSA (DELTA XTEND™, DePuy Synthes, Warsaw, IN, USA) to treat proximal humerus fractures. We used a standardized suture technique to reattach the tuberosities. Demographic, comorbidity, and radiological parameters were collected. Assessments at 2-year follow-up (n = 49) are given as follows: range of motion (ROM), pain level, Constant Murley scores (CS), subjective shoulder value (SSV), and tuberosity healing.

Results

Anatomic tuberosity healing was achieved in 31 (55%) patients (group 1), 14 (25%) had a malunion (group 2), and complete migration occurred in 11 (20%) (group 3). No statistically significant differences between groups 1 and 2 were detected: CS (p = 0.53), SSV (p = 0.07), ROM (forward flexion (FF) p = 0.19, internal rotation (IR) p = 0.34, and external rotation (ER) p = 0.76). Group 3 had poorer outcomes (median [IQR]) than group 1: CS (59 [50–71]) vs. 72 [65–78]), FF (120 [100–150]) vs. 150 [125–160] and ER (− 20 [− 20 to 10] vs. 30 [20–45], respectively. Three complications (group 1) occurred: one-stage revision after low-grade infection, haematoma due to early rivaroxaban intake, and open reduction and internal fixation for acromion insufficiency fracture. No patients showed signs of stem or glenoid loosening after 2 years.

Conclusion

Cases with complete superior migration experienced poorer clinical outcomes than those with anatomic healing. Despite a relatively high malunion rate, the outcomes were not significantly worse in these patients compared to anatomically healed GT cases.

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Authors and Affiliations

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

    Janic Fischer, JoEllen Welter, Nils Horn, Laurenz Jaberg & Florian Hess

  2. Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland

    Simon Graber

  3. Trauma Department, University Hospital Zurich, Zurich, Switzerland

    Hans-Christoph Pape

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  1. Janic Fischer
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Correspondence to Florian Hess.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Eastern Switzerland (EKOS 2019-00414).

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Fischer, J., Welter, J., Horn, N. et al. Is malunion of the greater tuberosity after reverse shoulder arthroplasty in patients with complex proximal humerus fracture associated with worse clinical outcomes? A prospective cohort study. Arch Orthop Trauma Surg 143, 6527–6533 (2023). https://doi.org/10.1007/s00402-023-04951-6

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