Tuberosity Healing after Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Is there Clinical Improvement?

Barros, Luís Henrique; Figueiredo, Sérgio; Marques, Manuel; Rodrigues, Claudia; Ramos, Joaquim; Claro, Rui

doi:10.1055/s-0039-3402459

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Revista Brasileira de Ortopedia

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Sumário

Original Article, Shoulder and elbow • Rev. bras. ortop. 55 (6) • Nov-Dec 2020 • https://doi.org/10.1055/s-0039-3402459 copy

Tuberosity Healing after Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Is there Clinical Improvement?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the functional results of patients with complex proximal humerus fracture submitted to total shoulder reverse arthroplasty with and without tuberosity healing. The secondary goal was to know the tuberosity healing rate after reverse shoulder arthroplasty with our surgical technique.

Methods

A retrospective, cohort type study, with a prospective database collection. In total, 28 patients fulfilled the inclusion criteria: age ≥ 65 years, reverse shoulder arthroplasty for complex proximal humerus fracture (type-3 or -4, according to Neer), and a minimum of 24 months of follow-up. At six months of follow-up, all of the patients were evaluated radiographically for tuberosity, and then they were divided into 2 groups: those with healed tuberosities and those with non-healed tuberosities. A clinical evaluation using the Constant score, active range of motion and the Visual Analog Scale (VAS) at the last follow-up was also performed.

Results

Tuberosity healing occurred in 21 patients (76.3%). There were statistically significant differences in the Constant scoring system (p < 0.001), forward elevation (p = 0.020), internal rotation (p = 0.001) and external rotation (p = 0.003) when comparing the group of healed tuberosities with the group of non-healed tuberosities. No differences were found regarding the VAS score.

Conclusion

Tuberosity healing results in an improvement of the functional outcomes of patients submitted to reverse shoulder arthroplasty as a treatment for complex proximal humeral fractures in the elderly.

Keywords
reverse shoulder arthroplasty; tuberosity healing; elderly fracture; proximal humeral fracture

Variable	Tuberosity healing		p-value
Variable	Yes (n = 21)	No (n = 7)	p-value
Female gender (%)	16 (76.2%)	6 (85.7%)	0.595^* * Chi-squared test.
Median age¹1 Sanders RJ, Thissen LG, Teepen JC, van Kampen A, Jaarsma RL. Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. J Shoulder Elbow Surg 2011;20(07):1118-1124 [minimum-maximum]	73.6 [60.2-82.1]	70.9 [60.7-89.8]	0.876^ Mann-Whitney U test.
Median follow-up period (months) [minimum-maximum]	56.5 [33.2-88.2]	46.8 [32.5-73.1]	0.140^ Mann-Whitney U test.

Functional evaluation	Tuberosity healing		p-value
Functional evaluation	Yes (n = 21)	No (n = 7)	p-value
Constant score	79.0 (5;0)	55.0 (11;0)	p < 0.001^* * p < 0.05.
Forward elevation	135.0º (46;0º)	90.0º (70;0º)	p = 0.02^* * p < 0.05.
Abduction	105.0º (45;0º)	75.0º (60;0º)	p = 0.435
Internal rotation	60.0º (45;0º)	30.0º (0;0º)	p = 0.01^* * p < 0.05.
External rotation	60.0º (32;5º)	30.0º (0;0º)	p = 0.03^* * p < 0.05.
Visual Analog Scale score	1.0 (0;5)	1.0 (1;0)	p = 0.836

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Luís Henrique Barros, MD, Centro Hospitalar e Universitário do Porto, Avenida da República, 855, 1°direito, Vila Nova de Gaia, 4430-040, Portugal (e-mail: luisbarros8@gmail.com).