Reverse Shoulder Arthroplasty for Humeral Head Fracture with Massive Rotator Cuff Tear in Elderly Patient

Oh Soo Kwon; Chang Yoon Moon; Weon Yoo Kim

doi:10.4055/jkoa.2011.46.2.152

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Kwon, Moon, and Kim: Reverse Shoulder Arthroplasty for Humeral Head Fracture with Massive Rotator Cuff Tear in Elderly Patient

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(2): 152-157.

Published online: 22 April 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.2.152

Reverse Shoulder Arthroplasty for Humeral Head Fracture with Massive Rotator Cuff Tear in Elderly Patient

Oh Soo Kwon, M.D., Ph.D., Chang Yoon Moon, M.D., Weon Yoo Kim, M.D., Ph.D.

Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea.

Correspondence to: Oh Soo Kwon, M.D., Ph.D. Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daehueng-dong, Jung-gu, Daejeon 301-723, Korea. TEL: +82-42-220-9248, FAX: +82-42-221-0429, oskn@catholic.ac.kr

Received 18 May 2009 Accepted 12 August 2009

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

There are several methods to treat anatomic neck fracture of humerus in elderly patients. It is not easy to obtain optimal clinical or radiological results because of unstable fixaton of fractured site attributed to multifractured osteoporotic tuberosities and combined massive rotator cuff tears in these patients. These factors often lead to high failure rate of implantation. Alternative methods of treatment have been proposed to reduce complications and improve shoulder functions. Reverse shoulder prosthesis was originally designed for patients with cuff tear arthropathy. Indications for reverse shoulder arthroplasty have expanded with initial success. However, there are few reports to perform reverse shoulder prosthesis in proximal humerus fracture. We performed reverse shoulder arthroplasty in a 74-year-old man with right anatomic neck fracture of humerus and concomitant massive rotator cuff tear.

Keywords: shoulder, anatomic neck fracture, massive rotator cuff tear, reverse prosthesis

Figures and Tables

Figure 1

(A, B) Plain radiographs show displaced humeral head fracture, subacromial spur and reduced acromiohumeral interval.

Figure 2

CT scan demonstrates anteriorly displaced humeral head fragment and arthritic changes on glenoid.

Figure 3

(A, B) 3D CT reveales humerus head fracture with inferomedial displacement of fractured head fragment.

Figure 4

(A, B) MR images show full thickness rotator cuff tears with retraction and muscle atrophy.

Figure 5

(A, B) Plain radiographs taken 12 months after implantation of reverse shoulder prosthesis.

Figure 6

(A, B) This patient showed 150° forward elevation and 50° external rotation at side 12 months after surgery.

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