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

Xavier Ohl (1) , Nicolas Bonnevialle (2) , David Gallinet (3) , Nassima Ramdane (4) , Philippe Valenti (5) , Lauryl Decroocq (6) , Pascal Boileau (6)

1 Hôpital universitaire Robert Debré [Reims]
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 Clinique Saint Vincent
4 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
5 Institut Parisien de l'Epaule
6 CHU Nice - Centre Hospitalier Universitaire de Nice

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.

Mots clés: Shoulder instability; Proximal humeral fractures; Complication; Greater tuberosity excision; Greater tuberosity healing; Reverse shoulder arthroplasty

Domaines: Chirurgie; Rhumatologie et système ostéo-articulaire

Xavier Ohl, Nicolas Bonnevialle, David Gallinet, Nassima Ramdane, Philippe Valenti, et al.. How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. Journal of Shoulder and Elbow Surgery, 2018, 27 (12), pp.2139-2144. ⟨10.1016/j.jse.2018.05.030⟩. ⟨hal-02135121⟩