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How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures

Ohl, Xavier and Bonnevialle, Nicolas and Gallinet, David and Ramdane, Nassima and Valenti, Philippe and Decroocq, Lauryl and Boileau, Pascal How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. (2018) Journal of Shoulder and Elbow Surgery, 27 (12). 2139-2144. ISSN 1058-2746

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Official URL: https://doi.org/10.1016/j.jse.2018.05.030

Abstract

BACKGROUND: Our purpose was to evaluate the clinical and radiologic outcomes of reverse shoulder arthroplasty for proximal humeral fractures in a large cohort of elderly patients and compare the results in the case of tuberosity excision, failed fixation, or anatomic healing. METHODS: In this retrospective multicenter study, 420 patients underwent review and radiography with a minimum follow-up period of 12 months. The patients were divided into 3 groups according to the status of the greater tuberosity (GT) on the last anteroposterior radiographs: anatomic GT healing (group A, n = 169); GT resorption, malunion, or nonunion (group B, n = 131); and GT excision (group C, n = 120). Complications were recorded; shoulder function, active mobility, and subjective results were assessed. RESULTS: At a mean follow-up of 28 months, the mean Simple Shoulder Value in group A (75%) outperformed the results found in groups B (69%, P < .001) and C (56%, P < .001). Overall, the mean adjusted Constant-Murley score was significantly higher in group A (93% ± 22%) than in group B (82% ± 22%) and group C (80% ± 24%) (P < .001), but there was no difference between groups B and C (P = .88). Anterior active elevation and external rotation were significantly better in group A than in groups B and C (P < .001). The instability rate was significantly higher in group C (n = 15 [12.5%], P < .001) than in group A (n = 2) or group B (n = 3). CONCLUSION: In elderly patients who have undergone a reverse shoulder arthroplasty for acute proximal humeral fractures, anatomic tuberosity healing improves objective and subjective outcomes. GT excision is associated with the worst functional results and increases the risk of postoperative shoulder instability.

Item Type:Article
HAL Id:hal-02135121
Audience (journal):International peer-reviewed journal
Uncontrolled Keywords:
Institution:Other partners > Centre Hospitalier Universitaire de Reims - CHU Reims (FRANCE)
Other partners > Centre Hospitalier Régional Universitaire de Lille - CHRU (FRANCE)
Other partners > Centre Hospitalier Universitaire de Nice - CHU Nice (FRANCE)
Other partners > Clinique Saint Vincent - Capio - Besançon (FRANCE)
Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
Other partners > Institut parisien de l'épaule (FRANCE)
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Deposited On:01 Apr 2019 09:24

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