gms | German Medical Science

Objectives: Fracture sequelae after failed operative treatment of proximal humerus fractures represents a very complex pathology of the shoulder joint and is often associated with adverse events and complications due to osseous defects, rotator cuff deficiency, numerous previous surgeries and stiffness. However, RSA is often the only therapeutic option left to improve patient satisfaction. Glenoidal lateralization may improve pretensioning of the deltoid muscle and the residual rotator cuff and reduce scapular notching.

Aim of this study was to evaluate complications as well as clinical and radiological results of RSA fracture sequelae situations.

Methods: This retrospective study from prospective data included patients who underwent RSA after failed operative treatment of a proximal humerus fracture. Inclusion criteria was previous reconstructive surgical treatment and secondary RSA implantation with or without metallic glenoid augmentation at one of two institutions with a minimum two year follow-up examination. All adverse events were recorded in addition to Constant Score (CS) and Subjective Shoulder Value (SSV) and range of motion, as well as radiographic evaluation was included.

Results and conclusion: 52 patients treated with RSA for fracture sequelae (female n=32, male n=20; Ø=66 years) were included. Adverse events resp. complications occurred in seven patients (reversible axillary palsy, instability, periprosthetic fracture, glenoid loosening), resulting in a complication rate of 13%, of which four (8%) led to revision). 16 patients were treated with metallic glenoid augmentation of the baseplate. Complication (no lateralization: traction damage axillary nerve n=2, instability n=1) (glenoid lateralization: traction damage axillary nerve n=1, instability n=1; loosening n=1; periprosthetic fracture n=1) and rates were comparable (11 vs. 18%) between both groups.

All patients treated for fracture sequelae improved statistically significant in CS, SSV (p<0.01) and all planes of range of motion (p<0.05) compared to baseline function.

Patients with glenoid lateralization showed superior flexion (p=0.04), abduction (p=0.03), external rotation (p=0.03) and significant lower rates of scapular notching (0% vs 16%).

RSA provides reliable clinical and radiographic results as a treatment option for patients with fracture sequelae. Since the rate of adverse events resp. complication leading to revision are similar in lateralized and non-lateralized designs we continue to use metallic glenoid augmentation in this specific patient cohort due to superior functionality after RSA.