In the JournalsPerspective

Tuberosity reattachment yielded high rate of healing for elderly patients

Results showed a high rate of tuberosity healing and good functional results when a specific reverse-fracture stem that incorporates bone graft was used in elderly patients undergoing tuberosity reattachment and reverse shoulder arthroplasty.

Researchers evaluated and collected radiographs of 38 shoulders with acute displaced or dislocated three- and four-part fractures in 37 elderly patients who underwent reattachment of the tuberosities around a reverse shoulder arthroplasty. All patients underwent a standardized suturing technique for tuberosity fixation with the Aequalis Reverse-Fracture Prosthesis (Tornier).

Results showed patients had a tuberosity union rate of 84%. Researchers found significantly lower subjective results and lower active mobility in forward elevation and external rotation among patients who experienced tuberosity resorptions (n=4) and tuberosity migration with nonunion (n=2). At 2-year follow-up, 87% reported being either satisfied or very satisfied with the results of the procedure. Of the five disappointed patients, researchers noted three patients presented with tuberosity resorption and two with tuberosity migration and nonunion.

According to the researchers, advantages to tuberosity reconstruction and healing in reverse should arthroplasty for fractures include the potential reduction of the risk of joint instability due to the reconstruction of the anterior and posterior soft tissue walls and restored humeral length.

“Second, the risk of infection is reduced because the periprosthetic dead space is minimized and the surrounding bone and soft tissues are better vascularized,” the authors wrote. “Third, the probability of humeral implant loosening is decreased because the stem is not solely reliant on distal fixation; the reconstructed bony envelope provides an additional proximal fixation for the semiconstraint prosthesis.” – by Casey Tingle

Disclosures: Boileau reports he receives royalties from Tornier/Wright. Please see the full study for a list of all other authors’ relevant financial disclosures.

Results showed a high rate of tuberosity healing and good functional results when a specific reverse-fracture stem that incorporates bone graft was used in elderly patients undergoing tuberosity reattachment and reverse shoulder arthroplasty.

Researchers evaluated and collected radiographs of 38 shoulders with acute displaced or dislocated three- and four-part fractures in 37 elderly patients who underwent reattachment of the tuberosities around a reverse shoulder arthroplasty. All patients underwent a standardized suturing technique for tuberosity fixation with the Aequalis Reverse-Fracture Prosthesis (Tornier).

Results showed patients had a tuberosity union rate of 84%. Researchers found significantly lower subjective results and lower active mobility in forward elevation and external rotation among patients who experienced tuberosity resorptions (n=4) and tuberosity migration with nonunion (n=2). At 2-year follow-up, 87% reported being either satisfied or very satisfied with the results of the procedure. Of the five disappointed patients, researchers noted three patients presented with tuberosity resorption and two with tuberosity migration and nonunion.

According to the researchers, advantages to tuberosity reconstruction and healing in reverse should arthroplasty for fractures include the potential reduction of the risk of joint instability due to the reconstruction of the anterior and posterior soft tissue walls and restored humeral length.

“Second, the risk of infection is reduced because the periprosthetic dead space is minimized and the surrounding bone and soft tissues are better vascularized,” the authors wrote. “Third, the probability of humeral implant loosening is decreased because the stem is not solely reliant on distal fixation; the reconstructed bony envelope provides an additional proximal fixation for the semiconstraint prosthesis.” – by Casey Tingle

Disclosures: Boileau reports he receives royalties from Tornier/Wright. Please see the full study for a list of all other authors’ relevant financial disclosures.

    Perspective
    Derek J. Cuff

    Derek J. Cuff

    This study reinforces the importance of properly repairing the greater tuberosity when performing reverse shoulder arthroplasty for comminuted proximal humeral fractures. Even in this elderly cohort, the authors were able to demonstrate a high tuberosity healing rate with this fracture-specific implant that was utilized. Healing of the greater tuberosity positively affected the patients’ range of motion in both elevation and external rotation, and when healed in an anatomic position, led to patient satisfaction with the procedure.

    • Derek J. Cuff, MD
    • Suncoast Orthopaedic Surgery and Sports Medicine
      Venice, Florida

    Disclosures: Cuff reports he is a consultant for DJO Surgical and Ignite Orthopedics.