Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis

Introduction: Reverse shoulder arthroplasty (RSA) is becoming popular in the treatment of complex proximal humeral fractures (PHFs). Greater tuberosity healing may influence functional outcomes and range of motion (ROM) of shoulder after RSA. In addition, the design of prosthesis may impact the healing rate of greater tuberosity. The purpose of this study is to know: (1) does the healing of greater tuberosity affect the functional outcomes and ROM of shoulder? and (2) does the design of prosthesis affect the healing rate of greater tuberosity?Materials and Methods: PubMed, Ovid/Embase, and the Cochrane Library were searched for studies comparing the clinical outcomes between the healed groups and the non-healed groups after RSA.Results: For functional outcomes, the results showed that the healed group had better Constant scores (CSs) (p < 0.0001). For ROM, the healed group showed better flexion (p < 0.0001), abduction (p = 0.02), and external rotation (p < 0.00001) of shoulder. For the design of prosthesis, the mean healing rate of greater tuberosity (82.7%) in patients with fracture-dedicated prosthesis was higher than those (63.0%) in patients with standard prosthesis. Subgroup analyses showed that the CS (p = 0.12) and abduction (p = 0.96) of patients using fracture-dedicated prostheses were not different between the healed groups and the non-healed groups. Meta-regression showed that there was no significant relationship between the design of prosthesis and CS (p = 0.312), flexion (p = 0.422), or external rotation (p = 0.776).Conclusion: Our meta-analysis showed that the healed groups could obtain better functional outcomes and ROM than the non-healed groups. In addition, fracture-dedicated prostheses promoted the healing rate of greater tuberosity.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276, PROSPERO: CRD42020157276.

A “Floating Glenoid” after a Reverse Total Shoulder Arthroplasty: A Case Report with Literature Review

A shoulder replacement for cuff tear arthropathy was the original indication of the reverse total shoulder arthroplasty (rTSA). However, over time, this particular concept of shoulder arthroplasty has found new indications for other pathologies such as complex proximal humeral fractures and irreparable rotator cuff tears with rotator cuff arthropathy. Retensioning of the deltoid muscle is a vital step during this procedure in order to restore active elevation however, this can be potentially problematic since it results in anatomical changes and often times increases the stress forces across the acromion. We experienced a rare case of an 84-year-old female presenting with an extensive fracture resulting in a “floating glenoid” after reverse total shoulder arthroplasty via a deltopectoral approach. In our case, the patient presented with gradual onset pain in the posterior shoulder with point tenderness over the acromion, which worsened during active joint movement. The patient was definitively managed with surgical removal of the glenoid implants and conversion to a hemiarthroplasty. While there are existing strategies for preventing fractures of this nature, further research is still necessary to establish best management guidelines of these fracture complications associated with rTSA in order to achieve optimal outcomes.

Locking Plate Fixation versus Hemiarthroplasty for Complex Proximal Humeral Fractures: an Updated Systematic Review and Meta-analysis

BackgroundThis updated systematic review and meta-analysis was performed to compare clinical efficacy and safety of locking plate fixation (LPF) and hemiarthroplasty (HAP) for surgical treatment of complex proximal humeral fractures (PHFs).MethodsFive electronic databases (PubMed, EMBASE, CNKI, Wanfang database and the Cochrane Library) were searched from their start dates to July 2020 to identify all relevant studies. Our main endpoints were Constant–Murley score (efficacy), and method-related complications and revisions (safety). Cochrane Collaboration’s RevMan 5.3 was used for meta-analysis.ResultsSixteen retrospective trials and one randomized controlled trial involving a total of 936 patients (506 patients in the LPF group and 430 patients in the HAP group) were included in this analysis. The Constant–Murley score was significantly higher with LPF than with HAP [SMD=0.73, 95%CI: (0.23, 1.22)]. In subgroup analysis however, there was no significant difference in Constant-Murley score between LPF and HAP for four-part fractures [SMD=0.35, 95%CI (-0.07, 0.77)] or for subjects over 60 years of age [SMD=0.54, 95%CI: (-0.45, 1.52)]. Revision rate [OR=3.61, 95%CI (1.99, 6.56)] and postoperative complications [OR=1.80, 95%CI (1.24, 2.61)] were significantly lower with HAP than with LPF.ConclusionsIn general, for treatment of complex PHFs, LPF was superior to HAP in postoperative shoulder joint function assessed by the Constant–Murley score. However, there was no significant difference in efficacy for patients with four-part fractures or those older than 60 years of age. Since LPF was associated with significantly higher revision and postoperative complications rates, we suggest that HAP should be considered the preferred procedure for patients older than 60 years with four-part proximal humeral fractures.

Reverse Total Shoulder Arthroplasty for Treatment of 3- and 4-Part Proximal Humeral Fractures: Clinical and Radiological Analysis With Minimum Follow-Up of 2 Years

Background: Hemiarthroplasty has been associated with inferior and unpredictable outcomes when used in the treatment of complex proximal humeral fractures in elderly patients. In this age-group, reverse shoulder arthroplasty is gaining popularity due to the promising results presented in recent evidence. Our aim is to analyze the cases of complex proximal humeral fractures treated by reverse shoulder arthroplasty, regarding functional results and complications. Materials and Methods: Thirty-five fractures from 33 patients with the mean age of 73.5 (65-81) years were treated with reverse shoulder arthroplasty for complex fractures of the proximal humerus. These patients were followed for a mean of 38.3 months (24-68) and analyzed regarding clinical outcomes and complications. Results: The average Quick-Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 6.8 points and 78.3%, respectively. The mean Constant score on the affected side was 64.4 points, 19.5% less than the nonoperated side. The mean active elevation was 123°, abduction 109°, external rotation 38°, and internal rotation 41°. The radiographic tuberosity healing rate was 85.7%. There were no significant differences in outcomes, between patient with healed and reabsorbed tuberosities. Inferior scapular notching was seen in 8 patients. The global complication rate was 12.8%. Conclusion: Reverse shoulder arthroplasty yields good and reproductive results with acceptable complication rates in selected elderly patients with complex proximal humeral fractures.