Reverse shoulder arthroplasty for fracture sequelae: Clinical outcome and prognostic factors.

Background: The reverse total shoulder arthroplasty (RTSA) is a common therapy for the fracture sequelae (FS) of the proximal humerus. The aim of this study was to show the short and midterm clinical outcome of the RTSA for FS and to identify prognostic factors.

Methods: Data from 46 patients with chronic FS who underwent RTSA were analysed. The clinical follow-up included the Constant score and radiographic examination. Patients were divided into groups based on the Boileau classification of FS, and the degree of metaphyseal bone loss was measured (Boileau type I 9 patients; type II 3 patients; type III 8 patients and type IV 16 patients). Scapular notching was assessed according to the classification of Sirveaux.

Results: The mean postoperative Constant score was 57. Clinical outcomes were similar among the various FS groups, as defined according to the Boileau classification, but patients who had undergone revision arthroplasty had a significantly inferior mean Constant score than patients with type IV FS. There were no significant differences between patients who were initially managed with conservative therapy and those treated surgically. Patients with metaphyseal bone loss >3 cm showed inferior clinical scores. Inferior scapular notching was seen in 25 patients, and had a negative effect on the clinical outcome. Complications included five infections and one dislocation.

Conclusion: Metaphyseal bone loss was unfavourable prognostic factors in patients with FS treated with RTSA. However, the Boileau classification did not serve as a prognostic criterion. Previous operative or conservative treatment had no influence on the outcome and scapular notching was associated with inferior clinical results.