SpringerLink
Log in

Tuberosity refixation improves functional outcome following primary reverse shoulder arthroplasty in proximal humeral fracture

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this prospective study was to examine clinical results of tuberosity refixation in RSA for the treatment of displaced PHF in elderly patients. We hypothesized that tuberosity refixation would increase clinical outcome.

Methods

In this prospective study, 50 patients were included after receive a primary RSA for complex proximal humeral fracture between March 2013 and December 2015 for follow-up after three, 12 and 24 months. A functional and radiological assessment was performed on the patients.

Results

At final follow-up after a mean period of 25.1 months, data were available for 30 women and 6 men (74% of the included overall study collective) with a mean age of 77 years (range 55–93 years) at time of surgery. The tuberosities were refixated in 74% (n = 37) and in 26% (n = 13) resected.

RSA with tuberosity refixation resulted in better clinical shoulder function compared to RSA with non-refixated tuberosities. The data show an external rotation with a significant difference (24.9° vs. 14°, p < 0.05) in favor of participants with refixation. The raw CMS was statistically significant (71.3 vs. 56.3, p < 0.05) after refixation, and SSV was significant improved (82.7% vs. 68%, p < 0.05) in the same group. Among 3 of 50 patients a total of 3 complications occurred with a total of 6% surgical revision.

Conclusions

In this prospective study, tuberosity refixation as part of fracture treatment using RSA results in better external rotation, subjective assessment of shoulder recovery (measured by SSV and by raw CMS) in elderly patients, compared with tuberosity excision.

Level of evidence

II, Prospective comparative study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bell JE, Leung BC, Spratt KF, Koval KJ, Weinstein JD, Goodman DC, Tosteson ANA (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Jt Surg Ser A 93(2):121–131

    Article  Google Scholar 

  2. Khatib O, Onyekwelu I, Yu S, Zuckerman JD (2015) Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization. J Shoulder Elbow Surg 24(10):e286-291. https://doi.org/10.1016/j.jse.2015.05.038

    Article  PubMed  Google Scholar 

  3. Klug A, Gramlich Y, Wincheringer D, Schmidt-Horlohe K, Hoffmann R (2019) Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg 139(12):1713–1721. https://doi.org/10.1007/s00402-019-03252-1

    Article  PubMed  Google Scholar 

  4. Bonnevialle N, Tournier C, Clavert P, Ohl X, Sirveaux F, Saragaglia D, la Societe francaise de chirurgie orthopedique et t, (2016) Hemiarthroplasty versus reverse shoulder arthroplasty in 4-part displaced fractures of the proximal humerus: multicenter retrospective study. Orthop Traumatol Surg Res 102(5):569–573. https://doi.org/10.1016/j.otsr.2016.02.014

    Article  CAS  PubMed  Google Scholar 

  5. Gallinet D, Ohl X, Decroocq L, Dib C, Valenti P, Boileau P, French Society for Orthopaedic S (2018) Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults A systematic review and meta-analysis. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2018.04.025

    Article  PubMed  Google Scholar 

  6. Sturzenegger M, Fornaro E, Jakob RP (1982) Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg 100(4):249–259. https://doi.org/10.1007/BF00381665

    Article  CAS  PubMed  Google Scholar 

  7. Mata-Fink A, Meinke M, Jones C, Kim B, Bell JE (2013) Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: a systematic review. J Shoulder Elbow Surg 22(12):1737–1748. https://doi.org/10.1016/j.jse.2013.08.021

    Article  PubMed  Google Scholar 

  8. Werthel JD, Sirveaux F, Block D (2018) Reverse shoulder arthroplasty in recent proximal humerus fractures. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2018.07.003

    Article  PubMed  Google Scholar 

  9. Cazeneuve JF, Cristofari DJ (2011) Long term functional outcome following reverse shoulder arthroplasty in the elderly. Orthop Traumatol Surg Res 97(6):583–589. https://doi.org/10.1016/j.otsr.2011.03.025

    Article  PubMed  Google Scholar 

  10. Anakwenze OA, Zoller S, Ahmad CS, Levine WN (2014) Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review. J Shoulder Elbow Surg 23(4):e73-80. https://doi.org/10.1016/j.jse.2013.09.012

    Article  PubMed  Google Scholar 

  11. Fortane T, Beaudouin E, Lateur G, Giraudo P, Kerschbaumer G, Boudhissa M, Tonetti J (2020) Tuberosity healing in reverse shoulder arthroplasty in traumatology: use of an offset modular system with bone graft. Orthop Traumatol Surg Res 106(6):1113–1118. https://doi.org/10.1016/j.otsr.2020.04.018

    Article  PubMed  Google Scholar 

  12. Gallinet D, Cazeneuve JF, Boyer E, Menu G, Obert L, Ohl X, Bonnevialle N, Valenti P, Boileau P, Societe Francaise de Chirurgie Orthopedique et al (2019) Reverse shoulder arthroplasty for recent proximal humerus fractures: outcomes in 422 cases. Orthop Traumatol Surg Res 105(5):805–811. https://doi.org/10.1016/j.otsr.2019.03.019

    Article  PubMed  Google Scholar 

  13. Levy JC, Badman B (2011) Reverse shoulder prosthesis for acute four-part fracture: tuberosity fixation using a horseshoe graft. J Orthop Trauma 25(5):318–324. https://doi.org/10.1097/BOT.0b013e3181f22088

    Article  PubMed  Google Scholar 

  14. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14(1):147S-161S. https://doi.org/10.1016/j.jse.2004.10.006

    Article  PubMed  Google Scholar 

  15. Schmalzl J, Jessen M, Holschen M, Cohen BC, Steinbeck J, Lehmann LJ, Denard PJ (2020) Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135 degrees prosthesis. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-020-02649-8

    Article  PubMed  Google Scholar 

  16. Ohl X, Bonnevialle N, Gallinet D, Ramdane N, Valenti P, Decroocq L, Boileau P, Sofcot (2018) How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.05.030

    Article  PubMed  Google Scholar 

  17. Garofalo R, Flanagin B, Castagna A, Lo EY, Krishnan SG (2015) Reverse shoulder arthroplasty for proximal humerus fracture using a dedicated stem: radiological outcomes at a minimum 2 years of follow-up-case series. J Orthop Surg Res 10:129. https://doi.org/10.1186/s13018-015-0261-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Levigne C, Boileau P, Favard L, Garaud P, Mole D, Sirveaux F, Walch G (2008) Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg 17(6):925–935. https://doi.org/10.1016/j.jse.2008.02.010

    Article  PubMed  Google Scholar 

  19. Gallinet D, Adam A, Gasse N, Rochet S, Obert L (2013) Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Shoulder Elbow Surg 22(1):38–44. https://doi.org/10.1016/j.jse.2012.03.011

    Article  PubMed  Google Scholar 

  20. Loew M, Heitkemper S, Parsch D, Schneider S, Rickert M (2006) Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus. J Bone Jt Surg Br 88(3):345–350. https://doi.org/10.1302/0301-620X.88B3.16909

    Article  CAS  Google Scholar 

  21. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11(5):401–412. https://doi.org/10.1067/mse.2002.124527

    Article  CAS  PubMed  Google Scholar 

  22. Obert L, Saadnia R, Tournier C, Bonnevialle N, Saragaglia D, Sirveaux F, La S (2016) Four-part fractures treated with a reversed total shoulder prosthesis: Prospective and retrospective multicenter study. Results and complications. Orthop Traumatol Surg Res 102(3):279–285. https://doi.org/10.1016/j.otsr.2016.01.019

    Article  CAS  PubMed  Google Scholar 

  23. Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Jt Surg Br 89(4):516–520. https://doi.org/10.1302/0301-620X.89B4.18435

    Article  CAS  Google Scholar 

  24. Cazeneuve JF, Cristofari DJ (2009) Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 95(5):325–329. https://doi.org/10.1016/j.otsr.2009.03.018

    Article  PubMed  Google Scholar 

  25. Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 22(10):698–704. https://doi.org/10.1097/BOT.0b013e31818afe40

    Article  PubMed  Google Scholar 

  26. Jain NP, Mannan SS, Dharmarajan R, Rangan A (2018) Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.09.006

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cazeneuve JF, Cristofari DJ (2010) The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Jt Surg Br 92(4):535–539. https://doi.org/10.1302/0301-620X.92B4.22450

    Article  CAS  Google Scholar 

  28. Grubhofer F, Wieser K, Meyer DC, Catanzaro S, Beeler S, Riede U, Gerber C (2016) Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg 25(10):1690–1698. https://doi.org/10.1016/j.jse.2016.02.024

    Article  PubMed  Google Scholar 

  29. Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R (2011) Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observat Clin Orthop Relat Res 469(12):3324–3331. https://doi.org/10.1007/s11999-011-2055-z

    Article  Google Scholar 

  30. Sebastia-Forcada E, Cebrian-Gomez R, Lizaur-Utrilla A, Gil-Guillen V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23(10):1419–1426. https://doi.org/10.1016/j.jse.2014.06.035

    Article  PubMed  Google Scholar 

  31. Chun YM, Kim DS, Lee DH, Shin SJ (2017) Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes? J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2016.11.034

    Article  PubMed  Google Scholar 

  32. Simovitch RW, Roche CP, Jones RB, Routman HD, Marczuk Y, Wright TW, Zuckerman JD (2019) Effect of tuberosity healing on clinical outcomes in elderly patients treated with a reverse shoulder arthroplasty for 3- and 4-part proximal humerus fractures. J Orthop Trauma 33(2):e39–e45. https://doi.org/10.1097/BOT.0000000000001348

    Article  PubMed  Google Scholar 

  33. Formaini NT, Everding NG, Levy JC, Rosas S (2015) Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique. J Shoulder Elbow Surg 24(11):e299-306. https://doi.org/10.1016/j.jse.2015.04.014

    Article  PubMed  Google Scholar 

  34. Uzer G, Yildiz F, Batar S, Binlaksar R, Elmadag M, Kus G, Bilsel K (2017) Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty? J Shoulder Elbow Surg 26(1):36–41. https://doi.org/10.1016/j.jse.2016.05.005

    Article  PubMed  Google Scholar 

  35. Knierzinger D, Heinrichs CH, Hengg C, Konschake M, Kralinger F, Schmoelz W (2018) Biomechanical evaluation of cable and suture cerclages for tuberosity reattachment in a 4-part proximal humeral fracture model treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.04.003

    Article  PubMed  Google Scholar 

  36. Mollon B, Mahure SA, Roche CP, Zuckerman JD (2017) Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2016.11.043

    Article  PubMed  Google Scholar 

  37. Jang YH, Lee JH, Kim SH (2020) Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty. Bone Jt J 102B(11):1438–1445. https://doi.org/10.1302/0301-620X.102B11.BJJ-2020-0449.R1

    Article  Google Scholar 

  38. Kaisidis A, Pantos PG, Heger H, Bochlos D, Selimas S, Oikonomoulas V (2014) Reverse shoulder arthroplasty for the treatment of three and four part fractures of the proximal humerus in patients older than 75 years old. Acta Orthop Belg 80(1):99–105

    PubMed  Google Scholar 

  39. Torrens C, Guirro P, Miquel J, Santana F (2016) Influence of glenosphere size on the development of scapular notching: a prospective randomized study. J Shoulder Elbow Surg 25(11):1735–1741. https://doi.org/10.1016/j.jse.2016.07.006

    Article  PubMed  Google Scholar 

  40. Gutierrez S, Levy JC, Frankle MA, Cuff D, Keller TS, Pupello DR, Lee WE 3rd (2008) Evaluation of abduction range of motion and avoidance of inferior scapular im**ement in a reverse shoulder model. J Shoulder Elbow Surg 17(4):608–615. https://doi.org/10.1016/j.jse.2007.11.010

    Article  PubMed  Google Scholar 

  41. Smith T, Baunker A, Kramer M, Hurschler C, Kaufmann M, Pastor MF, Wellmann M (2015) Biomechanical evaluation of inferior scapula notching of reverse shoulder arthroplasty depending on implant configuration and scapula neck anatomy. Int J Shoulder Surg 9(4):103–109. https://doi.org/10.4103/0973-6042.167932

    Article  PubMed  PubMed Central  Google Scholar 

  42. Nunes J, Andrade R, Azevedo C, Ferreira NV, Oliveira N, Calvo E, Espregueira-Mendes J, Sevivas N (2022) Improved clinical outcomes after lateralized reverse shoulder arthroplasty: a systematic review. Clin Orthop Relat Res 480(5):949–957. https://doi.org/10.1097/CORR.0000000000002065

    Article  PubMed  Google Scholar 

  43. Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20(1):146–157. https://doi.org/10.1016/j.jse.2010.08.001

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery at DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Alexander Derksen

  2. Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany

    Helmut Lill, Alexander Ellwein & Julia Imrecke

Authors
  1. Alexander Derksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helmut Lill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Ellwein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julia Imrecke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Derksen.

Ethics declarations

Conflict of interest

There is no conflicts of interest.

Compliance with ethical standards

No benefits have been or will be received from a commercial party related directly or indirectly to the subject matter of this article. Ethical standards were respected. Approval from the local ethics committee has been obtained (No.: 1840–2013). Informed consent is available from all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Derksen, A., Lill, H., Ellwein, A. et al. Tuberosity refixation improves functional outcome following primary reverse shoulder arthroplasty in proximal humeral fracture. Eur J Orthop Surg Traumatol 34, 1441–1448 (2024). https://doi.org/10.1007/s00590-023-03810-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03810-9

Keywords

Search

Navigation