Sequelae of Fractures of the Proximal Humerus: Surgical Classification and Limits of Shoulder Arthroplasty

Abstract

This prospective multicenter study of 71 sequelae of fractures of the proximal humerus treated using a nonconstrained shoulder prosthesis demonstrates that osteotomy of the greater tuberosity is the most important factor for the functional result (p=0.05) because of persistent nonunion and/or bone resorption. This allows two types of fracture sequelae to be distinguished, whose functional results are completely different: (a) Intracapsular, impacted fracture sequelae in which osteotomy of the greater tuberosity is not required. This type of sequelae, in which the greater tuberosity heals to the shaft with a slight malunion, includes cephalic collapse and necrosis (40 cases) and chronic, locked dislocations and fracture-dislocations (9 cases). (b) Extracapsular, disimpacted fracture sequelae in which an implant cannot be inserted without osteotomizing and repositioning the greater tuberosity. This type of sequelae, in which the greater tuberosity is not healed or heals away from the shaft, includes surgical neck non-unions (6 cases) and severe tuberosity malunions (16 cases). The necessity of performing a greater tuberosity osteotomy with the shoulder replacement in a fracture sequelae to reconstruct the proximal humerus should lead the surgeons to anticipate a ``limited goal result'' with a limited active anterior elevation, below the horizontal, and with residual pain.