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Results of Shoulder Arthroplasty in Acute Fractures of the Proximal Humerus

  • Conference paper
Shoulder Arthroplasty

Summary

Sixty-six patients with acute three and four-part proximal humeral fractures treated with humeral head replacement were reviewed and radiographed with an average follow-up of 19 months (12–57 months). At review, computed tomographic scans were available in 23 patients and scaled radiographs of both humeri were available in 39 patients. The most significant factors associated with a poor functional result were: (a) Migration of the greater tuberosity either posterior (29%) or superior (17%), leading to nonunion, malunion and late bone resorption. (b) Malposition of the prosthesis because of inappropriate length, the prosthesis being too proud (15%) or too low (29%) and/or excessive retroversion (14%). There was a clear correlation between prosthesis positioning and greater tuberosity migration (p=0.001): greater tuberosity migration was the consequence of malpositioning of the humeral prosthesis, particularly when the prosthesis was too proud, too retroverted. Multiple technical errors of prosthesis positioning may be associated and increase the risk of greater tuberosity detachment despite meticulous tuberosity reconstruction with associated bone graft and secure fixation with heavy nonabsorbable sutures. Prosthesis positioning is the key to greater tuberosity healing to the shaft and should be more accurate but is difficult because of the absence of proximal anatomical landmarks in three-and four-part fractures. The Aequalis fracture jig, a new device allowing for more accurate positioning of the prosthesis because of control of the humeral length and retroversion, has been designed because “eyeball” positioning of the prosthesis is insufficient. Its early use seems to be promissing.

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Authors
  1. P. Boileau
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  2. L. Tinsi
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  3. J. C. Le Huec
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  4. D. Molé
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  5. R. Sinnerton
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  6. G. Walch
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Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery Hôpital de L’Archet, University of Lyon, 116, Rue Antoine Charial, 69003, Lyon, France

    Gilles Walch M.D.

  2. Department of Orthopaedic Surgery Hôpital de L’Archet, University of Nice, 151, Route de Saint-Antoine de Ginestière, 06200, Nice, France

    Pascal Boileau M.D.

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© 1999 Springer-Verlag Berlin Heidelberg

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Boileau, P., Tinsi, L., Le Huec, J.C., Molé, D., Sinnerton, R., Walch, G. (1999). Results of Shoulder Arthroplasty in Acute Fractures of the Proximal Humerus. In: Walch, G., Boileau, P. (eds) Shoulder Arthroplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-58365-0_36

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  • DOI: https://doi.org/10.1007/978-3-642-58365-0_36

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63554-0

  • Online ISBN: 978-3-642-58365-0

  • eBook Packages: Springer Book Archive

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