The use of a large diameter glenosphere in Reverse Shoulder Arthroplasty for proximal humeral fractures in elderly patients undergoing tuberosity removal.

BACKGROUND AND AIM: Prosthetic replacement with reverse shoulder arthroplasty (RSA) is commonly indicated for complex proximal humerus fractures (PHFs) in elderly patients. Aim of this study was to evaluate the clinical and radiological outcomes of RSA performed for comminuted PHFs, without periprosthetic reconstruction of the tuberosities. Our hypothesis was that a large diameter glenosphere could ensure satisfactory RSA mobility and stability, regardless of tuberosity removal. METHODS: We selected 32 patients (4 men, 28 women) with comminuted PHFs who underwent RSA with tuberosity excision and implantation of a 44-mm glenosphere between 2009 and 2015. Active range of motion (ROM), stability, Constant-Murley Score (CMS) (1) and Subjective Shoulder Value (SSV) (2) were assessed one year and four years after surgery. RESULTS: Clinical and radiological information were collected for 23 patients (72%). At one-year follow-up, active anterior elevation (AE) was 96±28 degrees, external rotation with adducted arm (ER1) 9±7 degrees, external rotation with abducted arm (ER2) 14±10 degrees, internal rotation (IR) to L4; CMS was 56±10 and SSV 65±22. Clinical assessment at 4-year follow up showed a decrease in active ROM (AE was 88±20 degrees, ER1 8±2 degrees, ER2 12±10 degrees, IR to L4), CMS (52±9) and SSV (62±8). No RSA dislocation occurred during the study. In 4 patients, grade I glenoid notching without any sign of component loosening was observed 4 years after surgery. CONCLUSIONS: A large diameter glenosphere does not ensure results comparable to those achieved after RSA with tuberosity reconstruction. However, the 44-mm glenosphere was effective in preventing RSA instability.

Surgical treatment of radial head isolated Mason III fractures.

INTRODUCTION: In this retrospective study we have analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with bone resection or prosthesis. PATIENTS AND METHODS: This study includes 24 patients affected by fractures mentioned above and treated between July 2009 and November 2015. 15 patients (average age 48 y.o.) have been treated with prosthesis. The remaining 9 (average age 573) have been treated with a capitellectomy instead. From a clinical point of view, we have evaluated the patients according to main performance indicators such as range of motion, pain, instability and Mayo Elbow Performance Score as parameters. RESULTS: We have found similar results in both group, with an average MEPS value of 95 in the prosthesis group and 966 in the radial head resection group. The range of motion was similar too: between 1,3° and 1203° in the first group and between 4,4° and 120° in the second one. No significant complication has detected in any patient. DISCUSSION: According to most recent literature, it is not precisely defined how to treat isolated Mason III fractures, contrary to what is defined in more complex pattern, in which prosthesis are now evaluated as the best indication. Due to radial head limited contribution to elbow stability, in absence of other bony or ligamentous lesions both capitellectomy and prosthesis can be good treatment in this kind of fracture. CONCLUSION: According to our experience and to the most recent literature, we recommend prosthesis in patient younger than 50 y.o., high demanding or manual worker, while in other cases we think that radial head resection can be the treatment of choice.

WITHDRAWN: Surgical treatment of radial head isolated Mason III fractures.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) 2019 382­385, https://doi.org/https://doi.org/10.1016/j.injury.2018.11.044. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.