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Open AccessArticle

Onlay Uncemented Lateralized Reverse Shoulder Arthroplasty for Fracture Sequelae Type 1 with Valgus/Varus Malunion: Deltoid Lengthening and Outcomes

1
Orthopedics and Sport Medicine Unit, Campolongo Hospital, 84025 Salerno, Italy
2
Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Naples, Italy
3
Dipartimento Multidisciplinare di Specialità Medico-Chirurgiche ed Odontoiatriche, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
4
Orthopedic and Traumatology Unit, San Donà di Piave Hospital, 30027 Venice, Italy
5
Orthopaedic Division of Policlinico ‘G.B. Morgagni’, 95100 Catania, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(10), 3190; https://doi.org/10.3390/jcm9103190
Received: 6 August 2020 / Revised: 24 September 2020 / Accepted: 27 September 2020 / Published: 1 October 2020
The successful treatment of proximal humeral fractures remains challenging for shoulder surgeons, and failure rates are high, regardless of initial treatment. This study aimed to analyze the clinical and radiographic midterm results of onlay lateralized cementless stem reverse shoulder arthroplasty (RSA) in patients with valgus/varus malunion proximal humerus fracture sequelae without metaphyseal osteotomy. We retrospectively studied 35 cases with the diagnosis of fracture sequelae of the proximal part of the humerus with valgus/varus malunion. The mean duration of follow-up was 4.6 years (range, 2 to 7 years), and the mean time between fracture and arthroplasty was 6 years (1 to 32 years). Seventeen patients (48.6%) had initially been treated nonoperatively. The Constant score (CS), active range of motion, and radiographs of the affected shoulders, as well as the acromion to greater tuberosity (AGT) distance and deltoid length (DL), were analyzed before surgery and at their latest follow-up. A total of thirty-three patients (94.3%) rated their outcome as very good or good. Mean CS, forward flexion, and external rotation improved significantly (p < 0.0001), as did internal rotation and pain (p < 0.05). AGT distance significantly increased postoperatively from 14.7 to 43.3 mm, as did DL from 143 to 170 mm (p < 0.05). There was no correlation between the outcomes and valgus/varus deformity, previous surgeries, or AGT distance/DL. A total of four complications occurred (11.4%): two dislocations were detected (5.7%) and successfully revised with a longer cemented stem. Onlay lateralized uncemented stem RSA improves clinical outcomes and decreases complications when treating valgus/varus malunion fracture sequelae, avoiding intraoperative technical challenges, such as tuberosities osteotomy conscious of bone loss and proper deltoid tensioning. View Full-Text
Keywords: reverse shoulder prosthesis; fracture sequelae; post-traumatic arthritis; onlay lateralized uncemented stem; complications; deltoid wrapping; humerus fracture; tuberosities reverse shoulder prosthesis; fracture sequelae; post-traumatic arthritis; onlay lateralized uncemented stem; complications; deltoid wrapping; humerus fracture; tuberosities
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Romano, A.M.; Braile, A.; Casillo, P.; Nastrucci, G.; Susanna, M.; Di Giunta, A.; Ascione, F. Onlay Uncemented Lateralized Reverse Shoulder Arthroplasty for Fracture Sequelae Type 1 with Valgus/Varus Malunion: Deltoid Lengthening and Outcomes. J. Clin. Med. 2020, 9, 3190.

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