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Reverse shoulder prosthesis: A salvage option when proximal humeral fractures treatment fails G. Porcellini N. Lollino F. Campi F. Pegreffi P. Paladini Unit of Shoulder Surgery Cervesi Hospital Cattolica - Italy

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Page 1: P325

Reverse shoulder prosthesis:

A salvage option when proximal humeral

fractures treatment fails

G. Porcellini

N. Lollino

F. Campi

F. Pegreffi

P. PaladiniUnit of Shoulder Surgery

Cervesi HospitalCattolica - Italy

Page 2: P325

Reverse shoulder prosthesis: a salvage option when proximal humeral fractures treatment fails

G. Porcellini, N. Lollino, F. Campi, F. Pegreffi, P. Paladini

My disclosure is in the Final Program Book and in the AAOS database.

I have no potential conflicts with this presentation.

Page 3: P325

Displaced proximal humeral fractures are a real challenge!

Avascular necrosisNonunionArthritisMalunionImplant failure

Page 4: P325

Revision surgery mandatory

Releave pain

Restore shoulder function

Are the outcomes of a reverse shoulder prosthesis influenced by previous surgery?

Page 5: P325

Patients and Methods

• 15 Patients with Complex Humeral fractures– Mean age 67 (+/- 2 years)

• Group A– 8 Patients (ORIF)

• Group B– 7 Patients (Cemented Hemi-arthroplasty)

• More than one year from previous surgery– Evaluated scores:

• Constant Score• Flexion• VAS• Dash

Page 6: P325

Patients and Methods: Inclusion criteria

• Patients with previous hemiarthroplasty:– a) on X-ray and Ultrasound examination:

• - tuberosity resorption;• - radiolucencies around the stem of the

prosthesis• - glenoid and acromial arthritis• - not-reparable rotator cuff deficiency

– b) on clinical examination• - pain in everyday activities;• - ROM extremely limited (pseudoparalytic

shoulder)

Page 7: P325

Patients and Methods: Inclusion criteria

• Patients with previous ORIF:– a) on x-ray and on ultrasound exam

• - avascular necrosis• - malunion with malposition of the

tuberosities• - nonunion• - not-reparable rotator cuff deficiency

– b) on clinical examination• - pain in everyday activities;• - ROM extremely limited (pseudoparalytic shoulder)

Page 8: P325

Results

p> 0,05

Page 9: P325

Results

p> 0,05

Page 10: P325

Complications

Radial nerve palsy after hemiarthroplasty revision (1 patient)

Radial nerve surgical exploration

Postoperative haematomas (2 patients)

Page 11: P325

Results

No statistically differences between patients of group A and group B

1 excellent (14,3%) 5 satisfactory (71,4%) 1 unsatisfactory (14,3%)

group A

group B 3 excellent (37,5%) 2 satisfactory (25%) 3 unsatisfactory (37,5%)

Groups did not significantly differ about surgical time. (p>0,05)

Page 12: P325

Conclusion

Wall B, Nové-Josserand L, O'Connor DP, Edwards TB, Walch G.:Reverse total shoulder arthroplasty: a review of results according to etiology.J Bone Joint Surg Am. (2007) Jul;89(7):1476-1485

Outcomes of revision surgery with reverse shoulder prosthesis

good but less satisfactory than primary reverse implant

Outcomes independent from first treatment !!!

p > 0,05

Page 13: P325

Reverse shoulder prosthesis:

A salvage option when proximal humeral fractures

treatment fails

G. Porcellini

N. Lollino

F. Campi

F. Pegreffi

P. PaladiniUnit of Shoulder Surgery

Cervesi HospitalCattolica - Italy

THANKS