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Treatment of the Sequelae

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Simple and Complex Fractures of the Humerus

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Abstract

Treatment of sequelae after proximal humerus fractures represents a challenge for the shoulder surgeon. Changed bony configuration due to necrosis of the articular segment, malunion or nonunion of the tuberosities, and malalignment of the head leads to significant biomechanical alterations resulting in decreased range of motion, strength, and pain. Additionally, secondary restriction of soft tissues contributes to a poor functional outcome. Accurate imaging diagnostics including native X-rays and CT scans is necessary in order to evaluate bony anatomy. The classification according to Boileau is established including four types of fracture sequelae: type 1, posttraumatic avascular necrosis; type 2, chronic locked dislocation or fracture-dislocation; type 3, surgical neck nonunion; and type 4, severe tuberosity malunion. Meantime, several outcome studies showed the best treatment options for the various sequelae types. Avascular necrosis is best treated by anatomic shoulder arthroplasty including stemmed and stemless designs, as well as head resurfacing depending on the stage of necrosis. Total shoulder arthroplasty seems to provide superior results than hemiarthroplasty. Type 2 offers predictable results similar to type 1 undergoing anatomic shoulder arthroplasty. Surgical neck nonunions should be reconstructed achieving interfragmentary stability. Bone grafting at the nonunion side is not always necessary. Type 4 sequela with severe tuberosity malunion represents an indication for reverse shoulder arthroplasty, since greater tuberosity osteotomy is associated with unpredictable and usually poor results if combined with anatomic shoulder arthroplasty. However, an increased complication rate has to be considered with lower outcome scores in secondary shoulder arthroplasty if compared to primary fracture arthroplasty. Regarding a good outcome, near anatomic position of the tuberosities and an intact rotator cuff without fatty infiltration are of key importance.

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Authors and Affiliations

  1. Shoulder and Elbow Service, ATOS Clinic Munich, Effnerstrasse 38, Munich, Bavaria, 81925, Germany

    Mark Tauber MD

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  1. Mark Tauber MD
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Correspondence to Mark Tauber MD .

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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, CTO Hospital Turin, Turin, Italy

    Filippo Castoldi

  2. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Davide Blonna

  3. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Marco Assom

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Tauber, M. (2015). Treatment of the Sequelae. In: Castoldi, F., Blonna, D., Assom, M. (eds) Simple and Complex Fractures of the Humerus. Springer, Milano. https://doi.org/10.1007/978-88-470-5307-6_16

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  • DOI: https://doi.org/10.1007/978-88-470-5307-6_16

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