Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(06): 748-754
DOI: 10.1055/s-0039-3402459
Artigo Original
Ombro e cotovelo

Consolidação dos tubérculos na artroplastia reversa do ombro após fratura proximal do úmero: Existe melhoria nos resultados funcionais?

Article in several languages: português | English
Luís Henrique Barros 
1   Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
,
Sérgio Figueiredo
2   Departamento de Ortopedia, Centro Hospitalar de Leiria, Leiria, Portugal
,
Manuel Marques
3   Departamento de Ortopedia, Centro Hospitalar do Litoral Alentejano, Santiago do Cacém, Portugal
,
Claudia Rodrigues
1   Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
,
Joaquim Ramos
1   Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
,
Rui Claro
1   Departamento de Ortopedia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
› Author Affiliations
› Further Information
   Permissions and Reprints

Resumo

Objetivo Comparar os resultados funcionais entre pacientes com fratura complexa do úmero proximal submetidos a artroplastia reversa com tubérculos consolidados e tubérculos não consolidados. O objetivo secundário foi determinar a taxa de consolidação dos tubérculos com este tipo de prótese.

Métodos Estudo de tipo coorte, retrospectivo, com coleta prospectiva de dados. No total, 28 pacientes cumpriram os critérios de inclusão: idade superior a 65 anos, prótese reversa do ombro por fratura complexa do úmero proximal (3 ou 4 partes, segundo Neer), e tempo de seguimento mínimo de 24 meses. Aos seis meses, todos os pacientes foram avaliados radiograficamente quanto à consolidação dos tubérculos e divididos em dois grupos: grupo com tubérculos consolidados e grupo com tubérculos não consolidados. A avaliação funcional realizou-se segundo o sistema de pontuação de Constant, da amplitude de movimento ativo, e da Escala Visual Analógica (EVA) à data da última consulta. Registaram-se todas as complicações.

Resultados A consolidação dos tubérculos ocorreu em 21 pacientes (76,3%). Verificou-se diferenças estatisticamente significativas no sistema de pontuação de Constant (p < 0.001), elevação anterior (p = 0.020), rotação interna (p = 0.001) e externa (p = 0.003), quando se comparou o grupo dos tubérculos consolidados com o grupo dos tubérculos não consolidados. Não houve diferenças significativas na EVA entre os 2 grupos.

Conclusão A consolidação dos tubérculos traduz uma melhoria dos resultados funcionais em pacientes submetidos a artroplastia reversa do ombro como tratamento de fraturas complexas do úmero proximal em idosos.

Palavras-chave

artroplastia reversa do ombro - consolidação dos tubérculos - fratura em idade geriátrica - fratura do úmero proximal


Publication History

Received: 09 January 2019

Accepted: 15 August 2019

Article published online:
07 February 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Sanders RJ, Thissen LG, Teepen JC, van Kampen A, Jaarsma RL. Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. J Shoulder Elbow Surg 2011; 20 (07) 1118-1124
    CrossrefPubMedGoogle Scholar
  • 2 Khatib O, Onyekwelu I, Zuckerman JD. The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older. J Shoulder Elbow Surg 2014; 23 (09) 1356-1362
    CrossrefPubMedGoogle Scholar
  • 3 Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001; 72 (04) 365-371
    CrossrefPubMedGoogle Scholar
  • 4 Court-Brown CM, Garg A, McQueen MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. J Bone Joint Surg Br 2001; 83 (06) 799-804
    CrossrefPubMedGoogle Scholar
  • 5 Neer II CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52 (06) 1077-1089
    CrossrefPubMedGoogle Scholar
  • 6 Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP. Proximal humeral fracture treatment in adults. J Bone Joint Surg Am 2014; 96 (03) 251-261
    CrossrefPubMedGoogle Scholar
  • 7 Jobin CM, Galdi B, Anakwenze OA, Ahmad CS, Levine WN. Reverse shoulder arthroplasty for the management of proximal humerus fractures. J Am Acad Orthop Surg 2015; 23 (03) 190-201
    CrossrefPubMedGoogle Scholar
  • 8 Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 2009; 95 (01) 48-55
    CrossrefPubMedGoogle Scholar
  • 9 Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res 2012; 470 (12) 3483-3491
    CrossrefPubMedGoogle Scholar
  • 10 Sirveaux F, Roche O, Molé D. Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 2010; 96 (06) 683-694
    CrossrefPubMedGoogle Scholar
  • 11 Boileau P, Winter M, Cikes A. et al. Can surgeons predict what makes a good hemiarthroplasty for fracture?. J Shoulder Elbow Surg 2013; 22 (11) 1495-1506
    CrossrefPubMedGoogle Scholar
  • 12 Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 2002; 11 (05) 401-412
    CrossrefPubMedGoogle Scholar
  • 13 Garrigues GE, Johnston PS, Pepe MD, Tucker BS, Ramsey ML, Austin LS. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics 2012; 35 (05) e703-e708
    CrossrefPubMedGoogle Scholar
  • 14 Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br 2010; 92 (04) 535-539
    CrossrefPubMedGoogle Scholar
  • 15 Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 2007; 89 (04) 516-520
    CrossrefPubMedGoogle Scholar
  • 16 Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 2008; 22 (10) 698-704
    CrossrefPubMedGoogle Scholar
  • 17 Murachovsky J, Ikemoto RY, Nascimento LG, Fujiki EN, Milani C, Warner JJ. Pectoralis major tendon reference (PMT): a new method for accurate restoration of humeral length with hemiarthroplasty for fracture. J Shoulder Elbow Surg 2006; 15 (06) 675-678
    CrossrefPubMedGoogle Scholar
  • 18 Nalbone L, Adelfio R, D'Arienzo M. et al. Optimal positioning of the humeral component in the reverse shoulder prosthesis. Musculoskelet Surg 2014; 98 (02) 135-142
    CrossrefPubMedGoogle Scholar
  • 19 Lädermann A, Edwards TB, Walch G. Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop 2014; 38 (05) 991-1000
    CrossrefPubMedGoogle Scholar
  • 20 Pascal Boileau GW, Sumant G. Krishnan. Tuberosity Osteosynthesis and Hemiarthroplasty for Four-Part Fractures of the Proximal Humerus. Tecnhiques in Shoulder and Elbow Surgery. 2000
    PubMedGoogle Scholar
  • 21 Du S, Ye J, Chen H, Li X, Lin Q. Interventions for Treating 3- or 4-part proximal humeral fractures in elderly patient: A network meta-analysis of randomized controlled trials. Int J Surg 2017; 48: 240-246
    CrossrefPubMedGoogle Scholar
  • 22 Torrens C, Alentorn-Geli E, Mingo F, Gamba C, Santana F. Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes. J Orthop Surg (Hong Kong) 2018; 26 (01) 2309499018760132
    CrossrefPubMedGoogle Scholar
  • 23 Henninger HB, Barg A, Anderson AE, Bachus KN, Tashjian RZ, Burks RT. Effect of deltoid tension and humeral version in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg 2012; 21 (04) 483-490
    CrossrefPubMedGoogle Scholar
  • 24 Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 2005; 14 (1, Suppl S) 147S-161S
    CrossrefPubMedGoogle Scholar
  • 25 Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R. Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res 2011; 469 (12) 3324-3331
    CrossrefPubMedGoogle Scholar
  • 26 Valenti P, Katz D, Kilinc A, Elkholti K, Gasiunas V. Mid-term outcome of reverse shoulder prostheses in complex proximal humeral fractures. Acta Orthop Belg 2012; 78 (04) 442-449
    PubMedGoogle Scholar
  • 27 Jain NP, Mannan SS, Dharmarajan R, Rangan A. Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 2019; 28 (03) e78-e91
    CrossrefPubMedGoogle Scholar
  • 28 Boileau P, Alta TD, Decroocq L. et al. Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities?. J Shoulder Elbow Surg 2019; 28 (03) 437-444
    CrossrefPubMedGoogle Scholar
  • 29 Garofalo R, Flanagin B, Castagna A, Lo EY, Krishnan SG. Reverse shoulder arthroplasty for proximal humerus fracture using a dedicated stem: radiological outcomes at a minimum 2 years of follow-up-case series. J Orthop Surg Res 2015; 10: 129
    CrossrefPubMedGoogle Scholar
  • 30 Formaini NT, Everding NG, Levy JC, Rosas S. Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique. J Shoulder Elbow Surg 2015; 24 (11) e299-e306
    CrossrefPubMedGoogle Scholar