Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures

Injury. 2018 Sep:49 Suppl 2:S22-S26. doi: 10.1016/j.injury.2018.06.042.


Background: This study evaluates the clinical outcomes in patients with proximal humerus fractures (PHF) treated with reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed fixation that have more than 5 years of follow-up.

Materials and methods: This is a retrospective study of 270 RTSA. The inclusion criteria for this study consisted of patients initially treated with either open reduction and plate fixation (ORIF) or fixation using an intramedullary nail (IMN), who were managed with a single-stage revision to a RTSA, and had a minimum of 24 months clinical and radiological follow-up. Six patients with failed fixation of displaced PHF were revised with RTSA. One patient was excluded from the study because she died. Five shoulders were reviewed for the purpose of this study. The patients were evaluated using Constant score, relative Constant score and visual analogue scale for pain.

Results: The mean follow-up was 89 months (65-108). The mean absolute Constant score improved from 31, 81 to 44, 2 and the relative Constant score improved from 31,81% to 67,2%. Mean VAS improved from 6, 8 to 2. One patient rated their outcome excellent, 1good, 1 satisfied and 2 poor.

Conclusion: RTSA is an appropriate treatment as a revision surgery for failed fixation of PHF. Patients should be adequately warned that they will improve their function but may have complications following this salvage procedure.

Keywords: Failed proximal humeral fixation; Reverse shoulder arthroplasty.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Shoulder*
  • Female
  • Fracture Fixation, Internal / adverse effects*
  • Humans
  • Radiography
  • Range of Motion, Articular / physiology*
  • Reoperation*
  • Retrospective Studies
  • Shoulder Fractures / diagnostic imaging
  • Shoulder Fractures / physiopathology
  • Shoulder Fractures / surgery*
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery*
  • Treatment Failure