Resultados funcionales y radiográficos de la prótesis reversa y la reinserción del troquíter en pacientes con fracturas de húmero proximal

• Juan Martín Patiño ^[1] ; Carlos Eugenio Martínez ^[1] ; Bernardo Andres ^[1] ; Francisco López Bustos ^[1] ; César Ruiz ^[1] ; Hernán Fiminella ^[1] ; Julio Ferro ^[1] ; Alberto Garay ^[1]
  1. [1] Instituto Dupuytren, Ciudad Autónoma de Buenos Aires, Argentina
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 85, Nº. 2, 2020, págs. 133-138
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2020.85.2.994
• Títulos paralelos:
  • Functional and radiologic outcomes of reverse shoulder arthroplasty and greater tuberosity reattachment in proximal humerus fractures
• Enlaces
  • Texto completo  1    2    3  
• Resumen
  • español

    Objetivo: Comunicar los resultados funcionales y radiográficos de pacientes tratados con prótesis reversa por fracturas complejas. El objetivo secundario fue determinar la relación entre rangos de movilidad y puntaje ASES con la evolución radiográfica del troquíter.

    Materiales y Métodos: Se incluyeron 16 pacientes >65 años, tratados con prótesis reversa y reinserción del troquíter, entre 2013 y 2017, operados antes de las 4 semanas del trauma y con un seguimiento mínimo de 2 años. Se consignaron el puntaje ASES y el rango de movilidad activa. En las radiografías, se evaluaron la posición y la consolidación del troquíter, y se registraron las complicaciones y su tratamiento.

    Resultados: La media de la edad fue 74.5 años (RIC 66-78.5), 11 (69%) eran mujeres. Once fracturas (69%) eran a 4 fragmentos y 5, luxofracturas a 4 fragmentos. La media entre el trauma y la cirugía fue 9.4 días y el seguimiento, 29.5 meses. En 9 casos (56%), el troquíter presentó consolidación. Rotación interna: 5 pacientes alcanzaron la región glútea con el pulgar; 4, la vértebra T12; 4, la vértebra L3; 3, la T7. Las medianas de rotación externa y flexión anterior fueron 30° (RIC 17,5-40) y 100° (RIC 87,5-160). El puntaje ASES promedio fue 78,3 (RIC 63,3-87,4). No hubo una asociación estadísticamente significativa entre la evolución del troquíter y la flexión anterior y el puntaje (p = 0,24 y 0,52, respectivamente).

    Conclusión: La prótesis reversa en fracturas agudas con reinserción de las tuberosidades puede llevar a buenos resultados funcionales. No se encontró relación entre la consolidación del troquíter y el puntaje ASES.

  • English

    Objective: To report functional and radiologic outcomes of reverse shoulder arthroplasty (RSA) in patients with complex proximal hu-meral fractures. A second objective was to assess the relation between the greater tuberosity healing and the range of motion (ROM) and the American Shoulder and Elbow Surgeons (ASES) score. Materials and Methods: Sixteen patients treated between 2013 and 2017, older than 65 years old, operated before 4 weeks after the trauma, and with a minimum of 2-year follow-up were included. ASES scores and active ROMs were recorded. Greater tuberosity and the prosthesis position and healing were radiologically evalu-ated, and the complications and treatment were recorded. results: The median age was of 74.5 years (IQR 66-78.5), 11 patients were females (69%). According to Neer classification, 11 cases were four-part fractures and 5 were four-part fracture-dislocations. The average time between trauma and surgery was 9.4 days, and the average follow-up was of 29.5 months. The greater tuberosity was healed in 9 cases (56%). Internal rotation: 5 patients (31.25%) were able to reach up with their thumbs to gluteal level, 4 (25%) to T12, 3 (18.75%) to T7, and 4 (25%) to L3. The medians for external rotation and forward flexion were 30° (IQR 17.5°-40°) and 100° (IQR 87.5°-160°). The average ASES score was of 78.3 (IQR 63.3-87.4). There was no significant statistical relation between greater tuberosity healing and forward flexion or ASES score (P=0.24 and P=0.52, respectively). conclusion: The use of reverse prostheses for complex fractures with greater tuberosity reattachment could lead to good functional outcomes, low complication rates and reoperations. There was no significant statistical relation between ASES score and greater tuberosity healing or failure to heal.

• Referencias bibliográficas
  • Rosas S, Law TY, Kurowicki J, Formaini N, Kalandiak SP, Levy JC. Trends in surgical management of proximal humeral fractures in the Medicare...
  • Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three-and four-part fractures of the proximal...
  • Chun YM, Kim DS, Lee DH, Shin SJ. Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed...
  • Garofalo R, Flanagin B, Castagna A, Lo EY, Krishnan SG. Reverse shoulder arthroplasty for proximal humerus fracture using a dedicated stem:...
  • Grubhofer F, Wieser K, Meyer DC, Catanzaro S, Beeler S, Riede U, et al. Reverse total shoulder arthroplasty for acute head-splitting, 3- and...
  • Uzer G, Yildiz F, Batar S, Binlaksar R, Elmadag M, Kus G, et al. Does grafting of the tuberosities improve the functional outcomes of proximal...
  • Boileau P, Krishnan SG, Tinsi L,Walch G, Coste JS, Molé D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty...
  • Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal...
  • Formaini NT, Everding NG, Levy JC, Rosas S. Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the...
  • Levy JC, Badman B. Reverse shoulder prosthesis for acute four-part fracture: tuberosity fixation using a horseshoe graft. J Orthop Trauma...
  • Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty...
  • Boileau P, Winter M, Cikes A, Han Y, Carles M, Walch G, et al. Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder...
  • Matthewson G, Kooner S, Kwapisz, A, Leiter J, Old J, MacDonald P. The effect of subscapularis repair on dislocation rates in reverse shoulder...
  • Cazeneuve JF, Cristofari DJ, Charalambous CP, Abiddin Z, Mills SP, Rogers S, et al. The reverse shoulder prosthesis in the treatment of fractures...
  • Gallinet D, Adam A, Gasse N, Rochet S, Obert L. Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder...
  • Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA. Treatment of comminuted fractures of the proximal humerus in elderly patients...
  • Boileau P, Alta TD, Decroocq L, Sirveaux F, Clavert P, Favard L, et al. Reverse shoulder arthroplasty for acute fractures in the elderly:...
  • Ohl X, Bonnevialle N, Gallinet, D, Ramdane N, Valenti P, Decroocq J, et al. How the greater tuberosity affects clinical outcomes after reverse...