The clinical outcomes and tuberosity healing after reverse total shoulder arthroplasty for acute proximal humeral fracture using the turned stem tension band technique |
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| Institution: | 1. Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan;2. Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine, 1-12-1, Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan;1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan;2. Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, 1006-9 Agehocho, Kamitetsuna, Takahagi, Ibaraki, 3180004, Japan;1. Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan;2. Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan;1. Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan;2. School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan;3. Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan;4. Department of Mathematics Education, Faculty of Education, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki, Miyazaki, 889-2192, Japan;1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan;2. Department of Gastroenterological and General Surgery, St. Luke''s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan;3. Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan |
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| Abstract: | BackgroundRecent studies have reported the clinical effectiveness of tuberosity healing after reverse total shoulder arthroplasty in patients with proximal humeral fractures with respect to joint stability, long-term survival, and postoperative range of motion. However, it is challenging to achieve robust fixation of the fragile bone fragments in elderly patients. This study aimed to report on the radiographic and clinical outcomes of patients who underwent reverse total shoulder arthroplasty for acute proximal humeral fractures using a Turned stem Tension Band technique–a simple suture configuration that can apply a compressive force on both tuberosities at the same time.MethodsEighteen patients who underwent reverse total shoulder arthroplasty for complex proximal humeral fractures (age 80.4 ± 4.7 years, range 70–87 years), using our Turned stem Tension Band technique, were included in this study and evaluated postoperatively for range of motion, American Shoulder and Elbow Surgeons score, Numerical Rating Scale, and tuberosity healing, with minimum 2-years follow-up (mean 34.5 months, range 24–60 months).ResultsAt the final follow-up, mean range of motion results were active flexion, 119 ± 34°; active abduction, 116 ± 35°; active external rotation, 27 ± 12°; and active internal rotation, L3. Six of 11 (55%) patients with 4-part dislocated fractures had neurological disorders from the time of injury; of these, three patients obtained shoulder elevation under 90° at the final follow-up. The mean American Shoulder and Elbow Surgeons score was 77.3 ± 10.7, and the mean Numerical Rating Scale was 1.2 ± 0.9. Fifteen of 18 (83%) patients were satisfied with the results. The tuberosity healing rate was 100% (18 of 18).ConclusionsThe Turned stem Tension Band technique in reverse total shoulder arthroplasty for proximal humeral fractures provides a robust fixation, regardless of the fracture pattern, which results in a high tuberosity healing rate. |
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