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Reverse total shoulder arthroplasty with a humeral inclination of 135º for treatment of 3- and 4-part proximal humeral fractures: Clinical analysis with minimum follow-up of 2 years

MOJ Orthopedics & Rheumatology
Francisco de Brito,1 Luís Pires,2 Paulo Rego,2 Raul Alonso2

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Background: The reverse shoulder arthroplasty (RSA) is indicated for the treatment of proximal humerus fractures (PUF). To present day, there are limited data regarding the difference in functional outcomes of the RSA with a humeral inclination of 135º or 155º, in fracture context. The purpose of this study is to retrospectively analyze the functional outcomes of complex PUF treated with RSA with a humeral inclination of 135º. Materials and Methods: We carried out a retrospective study in which we analyzed 22 patients with PUF, who underwent RSA with a humeral inclination of 135º, between January 2017 and June 2019. Functional outcomes were measured through the Q-DASH and ASES scores. The Constant-Murley score (CS), active elevation (AA), abduction (ABD), internal rotation (IR), external rotation (ER), and abduction strength were obtained in both arms, using the contralateral shoulder as an estimative of preinjury function. Results: The patients were followed for a mean of 39.5 months. Seven patients were painfree while performing their daily activities. Thirteen referred minor pain in their usual activities and 2 reported moderate to very severe pain. The mean ASES and Quick-DASH scores were 80% and 18.1 points, respectively. The CS was 59 points, 13 points less than the nonoperated side. The average AA was 128º, ABD 123º, ER 27º, and IR 36º. We found no correlation between the age and ASES score or Q-DASH score and between ER and ASES or Q-DASH score, but we found a positive correlation between ASES score or Q-DASH score and AA, ABD and IR. Conclusion: RSA is a valid and reliable option in selected elderly patients with complex PUF. The choice of the RSA humeral inclination (135º Vs 155º) does not currently have defined criteria, 


proximal humerus fractures, reverse shoulder arthroplasty, humeral inclination of 135º, Q-DASH, ASES, constant-murley score