Non-unions of proximal humerus fracture? How about a reverse?

15 Jul,2014

proximal humerousWhat are the available options for someone who had a fracture of proximal shoulder, which hasn’t united? One, he has a painful shoulder and 2nd he has limited motion.

Mostly this will be found in old individuals with a poor bone stock, which was a contributory factor to non-union in the first place.

A traditional approach which fails very often would be to attempt refixation with bone grafting. However this may not result in union of the fracture besides giving him a very stiff shoulder.

A reverse shoulder replacement comes as a great rescue in these cases. Paul Grammont innovated the use of reverse shoulder in 1992. Since then reverse shoulder has been used in many rotator cuff arthropathy and irreparable rotator cuff. Its use in non unions of proximal humerus is also very valuable and is now considered as an extended indication. An anatomic replacement has also been tried in these in these unions, but since the greater tuberosity is not anatomical, this also gives very poor results.

There may be an absent subscapularis , a non healed and displaced greater tuberosity. Reverse shoulder prosthesis can still work in the absence of a subscapularis and definitely without a supraspinatus and greater tuberosity. Thus a reverse shoulder replacement is a great option in people above 60 with a failed fixation of proximal humerus fracture. It provides good pain relief and reasonably good return of range of shoulder movements.

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