Fractures Sequelae

  • Chiara Fossati
  • Alessandra Menon
  • Nicolò Cosmelli
  • Pietro Randelli


The treatment of glenohumeral fractures sequelae is often a challenge, and the reverse shoulder arthroplasty may help surgeons to treat the most difficult cases.

The implant of a reverse shoulder arthroplasty in sequelae secondary surgery is usually more complicated due to extensive scar tissue, which requires a wide lysis, and alterations of normal anatomical references, which can make it difficult to obtain stability of the prosthesis.

In order to obtain the implant stability, it is advisable to estimate the humeral cuts on the X-ray of the contralateral side and to choose the final stem and tray with the conjoint tendon tension evaluation, the “index test” and the shoulder range of motion.

Reverse shoulder arthroplasty in fracture sequelae can improve shoulder function and reduce pain; however, comparing with acute replacement for fractures management, late reverse shoulder prosthesis shows lower functional outcomes and higher number of complications.


Fractures sequelae Glenohumeral fractures Complications Treatment options Reverse shoulder arthroplasty Shoulder replacement 


Conflict of Interest

Prof. Pietro Randelli is consultant for DePuy and Arthrex. The other authors declare no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript.


  1. 1.
    Ruedi T, Buckley R, Moran CG. AO principles of fracture management. New York: George Thieme Verlag; 2007.Google Scholar
  2. 2.
    Patel S, Colaco HB, Elvey ME, Lee MH. Post-traumatic osteonecrosis of the proximal humerus. Injury. 2017;46:1878–84.CrossRefGoogle Scholar
  3. 3.
    Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elb Surg. 2004;13:427–33.CrossRefGoogle Scholar
  4. 4.
    Jakob R, Miniaci A. Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br. 1991;73:295–8.CrossRefGoogle Scholar
  5. 5.
    Xu J, Zhang C, Wang T. Avascular necrosis in proximal humeral fractures in patients treated with operative fixation: a meta-analysis. J Orthop Surg Res. 2014;9:31.CrossRefGoogle Scholar
  6. 6.
    Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ. The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br. 2003;85(4):611–7.CrossRefGoogle Scholar
  7. 7.
    Buchholz, R.W., Court-Brown, C.M, Heckman, JD, Tornetta, P, E. Rockwood and green’s fractures in adults. 7th ed. Lippincott Williams Wilkins Philadelphia 2010.Google Scholar
  8. 8.
    Visser CPJ, Coene LNJEM, Brand R, Tavy DLJ. Nerve lesions in proximal humeral fractures. J Shoulder Elb Surg. 2001;10:421–7.CrossRefGoogle Scholar
  9. 9.
    Boileau P, Chuinard C, Le Huec JC, Walch G, Trojani C. Proximal humerus fracture sequelae: impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res. 2006;442:121–30.CrossRefGoogle Scholar
  10. 10.
    Grubhofer F, et al. Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elb Surg. 2017;26:92–100.CrossRefGoogle Scholar
  11. 11.
    Hattrup SJ, Waldrop R, Sanchez-Sotelo J. Reverse total shoulder arthroplasty for posttraumatic sequelae. J Orthop Trauma. 2016;30:e41–7.CrossRefGoogle Scholar
  12. 12.
    Gigis I, Nenopoulos A, Giannekas D, Heikenfeld R, Beslikas T, Hatzokos I. Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly. Open Orthop J. 2017;11:108–18.CrossRefGoogle Scholar
  13. 13.
    Holton J, Yousri T, Arealis G, Levy O. The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature. Orthop Rev (Pavia). 2017;9:27–31.CrossRefGoogle Scholar
  14. 14.
    Raiss P, Edwards TB, da Silva MR, Bruckner T, Loew M, Walch G. Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae). J Bone Joint Surg Am. 2014;96:2070–6.CrossRefGoogle Scholar
  15. 15.
    Schliemann B, Theisen C, Kösters C, Raschke MJ, Weimann A. Reverse total shoulder arthroplasty for type I fracture sequelae after internal fixation of proximal humerus fractures. Arch Orthop Trauma Surg. 2017;137(12):1677–83.CrossRefGoogle Scholar
  16. 16.
    Seidl AJ, Williams GR, Boileau P. Challenges in reverse shoulder arthroplasty: addressing glenoid bone loss. Orthopedics. 2016;39:14–23.CrossRefGoogle Scholar
  17. 17.
    Greiner S, et al. The metaphyseal bone defect predicts outcome in reverse shoulder arthroplasty for proximal humerus fracture sequelae. Arch Orthop Trauma Surg. 2014;134:755–64.CrossRefGoogle Scholar
  18. 18.
    Garofalo R, Brody F, Castagna A, Ceccarelli E, Krishnan SG. Reverse shoulder arthroplasty with glenoid bone grafting for anterior glenoid rim fracture associated with glenohumeral dislocation and proximal humerus fracture. Orthop Traumatol Surg Res. 2016;102:989–94.CrossRefGoogle Scholar
  19. 19.
    Norris TR, Kelly JD, Humphrey CS. Management of glenoid bone defects in revision shoulder arthroplasty: a new application of the reverse total shoulder prosthesis. Tech Shoulder Elb Surg. 2007;8:37–46.CrossRefGoogle Scholar
  20. 20.
    Bateman E, Donald SM. Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results. J Shoulder Elb Surg. 2012;21:925–34.CrossRefGoogle Scholar
  21. 21.
    Bentley G. European surgical orthopaedics and traumatology. In: The EFORT textbook. Heidelberg: Springer; 2014.Google Scholar
  22. 22.
    Alentorn-Geli E, Guirro P, Santana F, Torrens C. Treatment of fracture sequelae of the proximal humerus: comparison of hemiarthroplasty and reverse total shoulder arthroplasty. Arch Orthop Trauma Surg. 2014;134:1545–50.CrossRefGoogle Scholar
  23. 23.
    Nikola C, Hrvoje K, Nenad M. Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture sequelae. Int Orthop. 2014;39:343–8.CrossRefGoogle Scholar
  24. 24.
    Sebastia-Forcada E, et al. Outcomes of reverse total shoulder arthroplasty for proximal humeral fractures: primary arthroplasty versus secondary arthroplasty after failed proximal humeral locking plate fixation. J Orthop Trauma. 2017;31(8):e236–40.CrossRefGoogle Scholar
  25. 25.
    Lévigne C, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2008;17:925–35.CrossRefGoogle Scholar
  26. 26.
    Seidl A, et al. Early versus late reverse shoulder arthroplasty for proximal humerus fractures: does it matter? Arch Bone Joint Surg. 2017;5(4):213–20.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Chiara Fossati
    • 1
    • 2
  • Alessandra Menon
    • 1
    • 2
  • Nicolò Cosmelli
    • 1
    • 2
  • Pietro Randelli
    • 1
    • 2
  1. 1.Laboratory of Applied Biomechanics, U.O.C. 1st DepartmentAzienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTOMilanItaly
  2. 2.Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly

Personalised recommendations