The clinical outcomes and tuberosity healing after reverse total shoulder arthroplasty for acute proximal humeral fracture using the turned stem tension band technique.

Abstract

BACKGROUND\nRecent studies have reported the clinical effectiveness of tuberosity healing after reverse total shoulder arthroplasty in patients with proximal humeral fractures with respect to joint stability, long-term survival, and postoperative range of motion. However, it is challenging to achieve robust fixation of the fragile bone fragments in elderly patients. This study aimed to report on the radiographic and clinical outcomes of patients who underwent reverse total shoulder arthroplasty for acute proximal humeral fractures using a Turned stem Tension Band technique-a simple suture configuration that can apply a compressive force on both tuberosities at the same time.\n\n\nMETHODS\nEighteen patients who underwent reverse total shoulder arthroplasty for complex proximal humeral fractures (age 80.4\xa0±\xa04.7 years, range 70-87 years), using our Turned stem Tension Band technique, were included in this study and evaluated postoperatively for range of motion, American Shoulder and Elbow Surgeons score, Numerical Rating Scale, and tuberosity healing, with minimum 2-years follow-up (mean 34.5 months, range 24-60 months).\n\n\nRESULTS\nAt the final follow-up, mean range of motion results were active flexion, 119\xa0±\xa034°; active abduction, 116\xa0±\xa035°; active external rotation, 27\xa0±\xa012°; and active internal rotation, L3. Six of 11 (55%) patients with 4-part dislocated fractures had neurological disorders from the time of injury; of these, three patients obtained shoulder elevation under 90° at the final follow-up. The mean American Shoulder and Elbow Surgeons score was 77.3\xa0±\xa010.7, and the mean Numerical Rating Scale was 1.2\xa0±\xa00.9. Fifteen of 18 (83%) patients were satisfied with the results. The tuberosity healing rate was 100% (18 of 18).\n\n\nCONCLUSIONS\nThe Turned stem Tension Band technique in reverse total shoulder arthroplasty for proximal humeral fractures provides a robust fixation, regardless of the fracture pattern, which results in a high tuberosity healing rate.