Reverse total shoulder arthroplasty for type I fracture sequelae after internal fixation of proximal humerus fractures

Arch Orthop Trauma Surg. 2017 Dec;137(12):1677-1683. doi: 10.1007/s00402-017-2789-5. Epub 2017 Sep 15.


Introduction: Complications after internal fixation of proximal humerus fracture are common and may require surgical revision. Reverse total shoulder arthroplasty (RTSA) is frequently performed in such cases. The aim of the present study was to evaluate the functional results and complications after RTSA for the treatment of type I fracture sequelae after internal fixation of proximal humerus fractures.

Materials and methods: 26 patients (18 female, 8 male) underwent surgical revision of type I fracture sequelae of the proximal humerus after locking plate (n = 22) or intramedullary nail (n = 4) fixation. The mean age of the patients at the time of the revision was 75 years (range 65-89). After a mean follow-up of 36 months (range 18-58), clinical examination was performed and the age- and gender-related Constant-Murley Score (CMS) and the Oxford Shoulder Score (OSS) were obtained from all patients and compared to the pre-revision values.

Results: The mean age- and gender-related CMS of the affected shoulder increased from 44% (range 17-65) to 73% (range 44-97). This difference was statistically significant (p < 0.001). The CMS of the unaffected shoulder was 93% (range 72-98). This relates to a ratio in the CMS of 78% between the affected and the contralateral shoulder. The mean OSS was 28 points (range 12-54) for the operated shoulder and 43 points (range 34-48) for the unaffected side, resulting in 66% ratio. Again, the OSS improved significantly when compared with the preoperative values (p < 0.001). A total of five complications including two periprosthetic fractures were observed and required surgical revision.

Conclusion: Satisfying results can be obtained with RTSA as a salvage procedure for type I fracture sequelae after previous internal fixation of proximal humerus fractures.

Keywords: Fracture sequelae; Internal fixation; Proximal humerus fracture; Reverse total shoulder arthroplasty.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Shoulder / methods*
  • Bone Nails
  • Bone Plates
  • Female
  • Fracture Fixation, Internal / adverse effects*
  • Humans
  • Humerus / surgery
  • Male
  • Middle Aged
  • Postoperative Complications / surgery*
  • Reoperation*
  • Shoulder Fractures / surgery*
  • Treatment Outcome