Nimesh P Jain1, Syed S Mannan2, Ramasubramanian Dharmarajan2, Amar Rangan3. 1. Department of Trauma and Orthopaedics, North Cumbria University Hospitals National Health Service Trust, Carlisle, Cumbria, UK. Electronic address: nimeshortho24@gmail.com. 2. Department of Trauma and Orthopaedics, North Cumbria University Hospitals National Health Service Trust, Carlisle, Cumbria, UK. 3. Department of Orthopaedics, The James Cook University Hospital, South Tess National Health Service Foundation Trust, Middlesbrough, UK; Faculty of Medical Sciences and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Health Sciences, University of York, York, UK.
Abstract
BACKGROUND: Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus in older patients. Anatomic tuberosity healing in RSA has been recognized to restore better shoulder function. We compared the reported clinical and functional outcomes of RSA in proximal humeral fractures with and without tuberosity healing. METHODS: We performed a systematic review of literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials. We included all studies with RSA for proximal humeral fractures in patients older than 60 years and compared outcomes based on tuberosity healing with minimum follow-up of 12 months. RESULTS: Seven studies met the inclusion criteria. A total of 381 patients (382 shoulders) were identified. There were 53 men (18.3%) and 236 women (81.7%), with mean age of 76.83 years (range, 74-81 years). Mean follow-up duration was 29.84 months (range, 24-90 months), and the mean rate of greater tuberosity healing was 70.5%. Patients with healed tuberosity had significantly better active forward flexion (134.1° vs. 112.5°, P < .05), abduction (114.8° vs. 95.1°, P < .05), external rotation with elbow by the side (27.8° vs. 7.6°), and mean Constant score (63.5 vs. 56.6, P < .05) than with those with nonhealed tuberosity. CONCLUSION: The RSA group with healed greater tuberosity showed better range of motion, especially forward flexion and external rotation and Constant scores, compared with the nonhealed greater tuberosity group. Tuberosity healing may influence overall shoulder function after RSA for proximal humeral fractures in the elderly, and this needs verification with future prospective studies.
BACKGROUND: Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus in older patients. Anatomic tuberosity healing in RSA has been recognized to restore better shoulder function. We compared the reported clinical and functional outcomes of RSA in proximal humeral fractures with and without tuberosity healing. METHODS: We performed a systematic review of literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials. We included all studies with RSA for proximal humeral fractures in patients older than 60 years and compared outcomes based on tuberosity healing with minimum follow-up of 12 months. RESULTS: Seven studies met the inclusion criteria. A total of 381 patients (382 shoulders) were identified. There were 53 men (18.3%) and 236 women (81.7%), with mean age of 76.83 years (range, 74-81 years). Mean follow-up duration was 29.84 months (range, 24-90 months), and the mean rate of greater tuberosity healing was 70.5%. Patients with healed tuberosity had significantly better active forward flexion (134.1° vs. 112.5°, P < .05), abduction (114.8° vs. 95.1°, P < .05), external rotation with elbow by the side (27.8° vs. 7.6°), and mean Constant score (63.5 vs. 56.6, P < .05) than with those with nonhealed tuberosity. CONCLUSION: The RSA group with healed greater tuberosity showed better range of motion, especially forward flexion and external rotation and Constant scores, compared with the nonhealed greater tuberosity group. Tuberosity healing may influence overall shoulder function after RSA for proximal humeral fractures in the elderly, and this needs verification with future prospective studies.
Authors: Yaiza Lopiz; Carlos García-Fernandez; María Vallejo-Carrasco; Daniel Garriguez-Pérez; Loreto Achaerandio; Carmen Tesoro-Gonzalo; Fernando Marco Journal: Int Orthop Date: 2022-01-16 Impact factor: 3.075
Authors: Jonathan W Cheah; Edward L Baldwin; Jeffrey A O'Donnell; Gregory Pereira; Danica D Vance; Tally E Lassiter; Oke A Anakwenze Journal: JSES Int Date: 2020-08-26
Authors: Georg Siebenbürger; Evi Fleischhacker; Johannes Gleich; Tobias Helfen; Wolfgang Böcker; Ben Ockert Journal: Geriatr Orthop Surg Rehabil Date: 2021-07-07