While in reverse shoulder arthroplasty, the anatomy is reversed to a glenoid ball (glenosphere) and concave proximal humerus component. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) arising from the scapular body and inserted into greater and lesser tuberosities provide a compressive force and act as dynamic stabilizers during glenohumeral motion. The humeral neck-shaft angle of 130-140 degrees creates a shearing force at the glenohumeral joint during shoulder movements. The humeral head is retroverted about 20 degrees in relation to the distal humerus inter-epicondylar axis. The glenoid is titled upward about five degrees and retroverted about five degrees from the scapular body axis. The shallow glenoid is deepened by the circumferential glenoid labrum that along with the capsule and ligaments form the static stabilizers. Our study aimed to evaluate the outcomes of the use of trabecular metal RSA with a minimum three-year follow-up performed by a single surgeon.īiomechanically, the glenohumeral joint of the shoulder is a multiaxial ball and socket articulation between the humeral head, and a shallow pear-shaped bony glenoid to permit a wide range of motion. The emergence of reverse shoulder arthroplasty (RSA) has been able to provide better function though not always equivalent to preinjury levels in these patients. Hemiarthroplasty is an option in these patients, but functional results are unpredictable this is largely due to a deficiency of tuberosity healing including migration, resorption, and malunion. Reconstruction of these fractures with poor bone quality is associated with avascular necrosis and a high incidence of implant failure. Displaced three or four-part fractures, particularly in elderly patients, present with challenges. Most of the minimally displaced fractures are managed conservatively. These fractures are common in elderly patients and treatment can be challenging, especially when they are displaced and un-reconstructible. The prevalence of proximal humerus fractures (PHF) accounts for around 4-10% of all fractures as reported in several studies conducted in different populations. RSA is certainly a rewarding surgery in patients with complex PHF and was associated with good post-operative OSS along with patient satisfaction, and positive radiological outcomes at minimum three-year follow-up. Revision rate was 5.8% at mean follow-up of five years and one month (range: three years to nine years two months). Greater tuberosity union following intra-operative repair was evident on radiographs in 61.7% of the patients. The overall complication rate was 11.7%, and none of the patients had deep infections, scapular notching, or acromial fractures. Patients had good range of motion and mean OSS of 40.28 post-operatively. Thirty-four patients in total were followed up. Two patients who had surgery beyond four weeks post-injury were excluded. Four of them had developed severe dementia and were excluded as an outcome score from them could not be acquired. Two patients were lost to follow-up and nine patients died due to other causes. The mean follow-up duration was 5.08 years. Complications were addressed accordingly during treatment and follow-up. Oxford shoulder score (OSS) along with relevant patient information relating to demographics and functional outcomes were collected at regular intervals in outpatient clinic follow-ups. Mean age was 76 years (range: 61-91 years). This included 44 females and seven males. This study is a retrospective case series of 51 patients who underwent a trabecular metal RSA for non-reconstructable, acute three or four-part PHF performed by a single surgeon between 20 with a minimum follow-up of three years. Reverse shoulder arthroplasty (RSA) is becoming increasingly popular as a primary procedure for complex proximal humeral fractures (PHF) in acute trauma due to more emerging evidence and better patient outcomes.
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