Two 2 mm holes were drilled through the humeral shaft on either side of the bicipital groove, and then heavy non-absorbable sutures were passed through each hole. Glenoid base plate was impacted as low as possible and secured in place with 3–4 screws. The glenoid was reamed with cannulated reamer over a guidewire with 10° inferior tilt. The tuberosities were carefully retracted, and the shoulder joint was opened through the fracture at the level of rotator interval to retrieve the humeral head and expose the glenoid. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded from the study.Īll the patients were operated in beach chair position, and the prosthesis (DePuy, DELTA XTEND™) was implanted through the deltopectoral approach. Inclusion criteria were: displaced 3- or 4-part PHF (Neer's classification) less than 2-week-old duration, age ≥ 65 years, and treated with RSA along with tuberosity repair. ![]() Approval of our institutional ethical committee was obtained beforehand. The present study aims to find the efficacy of meticulous anatomic tuberosity repair in RSA for displaced PHF.Īn interventional study was undertaken in our institution from July 2013 to November 2019. Many papers have examined the overall outcome of RSA in PHF, but very few papers have investigated on this specific issue of the need of tuberosity healing and its impact on functional outcome of RSA. However, it remains a tempting concept whether we can go further in terms of the functional outcome with RSA by doing a successful tuberosity repair. It may be safely said that reverse replacement without a successful repair of tuberosity is still better than HA without a successful repair. Rotational movements are crucial for activities of daily living and personal hygiene. 12, 13, 14 Moreover the tuberosity healing is also difficult to obtain in elderly patients due to their limited potential for bone union.Īs far as the complications concerned, the major clinical and functional issues following treatment of comminuted PHF with RSA were restriction of internal or external rotation, forward flexion, overhead activities and scapular notching. 10, 11 Currently, RSA is continued to be favored by many orthopaedic surgeons as a better alternative to HA, because it is believed that functional results following RSA are not solely dependent upon anatomic tuberosity healing. 8, 9, 10, 11 However, with time, it was also observed that in revision surgeries for failed HA with lysis of tuberosity, the ROM of the shoulder was not very satisfactory even when shifted to RSA. 3, 5, 6, 7, 8, 9 On the contrary, compared to HA, reverse shoulder arthroplasty (RSA) offers an easier rehabilitation, and a fairly better range of movement (ROM) and subjective shoulder scores even in the absence of tuberosity healing, which is why it is favored by many orthopaedic surgeons. 1, 2 Similarly, complications like instability, infection and loosening have been reported in greater number when the tuberosity fails to heal. 4 Many previous studies have shown that the clinical outcomes after HA for PHF are disappointing, if the tuberosity fail to heal. 3 Fracture comminution, split humeral head, associated dislocation, osteoporosis, osteonecrosis of the humeral head and post-traumatic arthritis present numerous challenges in this fracture cohort. 1, 2 Failure of tuberosity healing, pre-existing osteoporosis, lack of compliance with rehabilitation regime lead to a poor functional outcome. However, the functional outcome with HA has largely remained unsatisfactory in various reports. ![]() Displaced 3- and 4-part PHF in elderly patients have been treated with hemiarthroplasty (HA) and fixation of tuberosity. Proximal humeral fractures (PHF) are the second most common upper extremity fracture and the third most common non-vertebral osteoporotic fracture, which also account for 10% of all fractures in the age group of 65 years and above.
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |