Treatment of cephalotuberosity fractures in elderly patients treated by reverse shoulder prosthesis: a study of functional results in relation to deltoid tension

  • Pierre-Sylvain MarcheixEmail author
  • Isaline Bazin
  • Guillaume Vergnenegre
  • Christian Mabit
  • Jean-Louis Charissoux
Original Paper



The treatment of proximal humerus fractures is a therapeutic challenge in the elderly as the functional demands of these patients are high. We postulated that there may be a relationship between functional results and deltoid tension when these fractures are treated with a reverse prosthesis. This study was performed to determine the optimal tension of the deltoid. The primary outcome was the constant score in relation to humeral length at the final follow-up.

Materials and methods

Our retrospective cohort consisted of 45 patients treated with a reverse fracture prosthesis during the period from January 2010 to July 2017. The fractures were all classified as Neer III or IV, 91% of our patients were women and the average age was 82 years.


Constant score and antepulsion were improved with humeral elongation between 10 and 25 mm (p < 0.02 and p < 0.05, respectively). External rotation was improved with humeral elongation (p < 0.03).


Tuberosity reinsertion improves mobility in patients treated surgically for a reverse fracture prosthesis. The recovery of anatomical retroversion seems of fundamental importance, and we confirmed that deltoid tension that must also be taken into account to improve functional results of reverse shoulder prosthesis on fracture. The ideal humeral elongation seems to be between 10 and 25 mm, in relation to the contralateral side, to obtain better functional results.


Deltoid tension Reverse shoulder prosthesis Proximal humerus fracture Geriatric trauma Functional results Radiological results 


Compliance with Ethical standards

A study accepted by the ethics committee of our institution.

Competing interests

The authors declare that they have no competing interests.


  1. 1.
    Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I (1996) Increasing number and incidence of osteoporotic fractures of the proximal humerus in elderly people. BMJ 313(7064):1051–1052CrossRefGoogle Scholar
  2. 2.
    Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92CrossRefGoogle Scholar
  3. 3.
    Obert L, Saadnia R, Tournier C, Bonnevialle N, Saragaglia D, Sirveaux F, La S (2016) Four-part fractures treated with a reversed total shoulder prosthesis: prospective and retrospective multicenter study. Results and complications. Orthop Traumatol Surg Res 102(3):279–285. CrossRefPubMedGoogle Scholar
  4. 4.
    Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elb Surg 11(5):401–412CrossRefGoogle Scholar
  5. 5.
    Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G, Hubner C, Resch H (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg (Br) 86(2):217–219CrossRefGoogle Scholar
  6. 6.
    Sirveaux F, Roche O, Mole D (2010) Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 96(6):683–694. CrossRefPubMedGoogle Scholar
  7. 7.
    Ladermann A, Walch G, Lubbeke A, Drake GN, Melis B, Bacle G, Collin P, Edwards TB, Sirveaux F (2012) Influence of arm lengthening in reverse shoulder arthroplasty. J Shoulder Elb Surg 21(3):336–341. CrossRefGoogle Scholar
  8. 8.
    Ladermann A, Williams MD, Melis B, Hoffmeyer P, Walch G (2009) Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elb Surg 18(4):588–595. CrossRefGoogle Scholar
  9. 9.
    Jobin CM, Brown GD, Bahu MJ, Gardner TR, Bigliani LU, Levine WN, Ahmad CS (2012) Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization. J Shoulder Elb Surg 21(10):1269–1277. CrossRefGoogle Scholar
  10. 10.
    Werner BS, Ascione F, Bugelli G, Walch G (2017) Does arm lengthening affect the functional outcome in onlay reverse shoulder arthroplasty? J Shoulder Elb Surg 26(12):2152–2157. CrossRefGoogle Scholar
  11. 11.
    Ladermann A, Edwards TB, Walch G (2014) Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop 38(5):991–1000. CrossRefPubMedGoogle Scholar
  12. 12.
    Neer CS 2nd (2006) Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res 442:77–82CrossRefGoogle Scholar
  13. 13.
    Ladermann A, Lubbeke A, Melis B, Stern R, Christofilopoulos P, Bacle G, Walch G (2011) Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am 93(14):1288–1293. CrossRefPubMedGoogle Scholar
  14. 14.
    Lowe JT, Lawler SM, Testa EJ, Jawa A (2018) Lateralization of the glenosphere in reverse shoulder arthroplasty decreases arm lengthening and demonstrates comparable risk of nerve injury compared with anatomic arthroplasty: a prospective cohort study. J Shoulder Elb Surg 27(10):1845–1851. CrossRefGoogle Scholar
  15. 15.
    Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 22(10):698–704. CrossRefPubMedGoogle Scholar
  16. 16.
    Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R (2011) Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res 469(12):3324–3331. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bufquin T, Hersan A, Hubert L, Massin P (2007) 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) 89(4):516–520. CrossRefGoogle Scholar
  18. 18.
    Pape G, Tonne L, Raiss P, Loew M, Zeifang F (2013) Prostheses for fractures of the proximal humerus: presentation of current results of anatomical fracture shoulder prosthesis under consideration of alternative concepts. Orthopade 42(3):164–169. CrossRefPubMedGoogle Scholar
  19. 19.
    Mattiassich G, Marcovici LL, Krifter RM, Ortmaier R, Wegerer P, Kroepfl A (2013) Delta III reverse shoulder arthroplasty in the treatment of complex 3- and 4-part fractures of the proximal humerus: 6 to 42 months of follow up. BMC Musculoskelet Disord 14:231. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Cazeneuve JF, Cristofari DJ (2010) The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg (Br) 92(4):535–539. CrossRefGoogle Scholar
  21. 21.
    Gallinet D, Adam A, Gasse N, Rochet S, Obert L (2013) Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Shoulder Elb Surg 22(1):38–44. CrossRefGoogle Scholar
  22. 22.
    Chun YM, Kim DS, Lee DH, Shin SJ (2017) Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes? J Shoulder Elb Surg 26(7):1216–1221. CrossRefGoogle Scholar
  23. 23.
    Boileau P, Alta TD, Decroocq L, Sirveaux F, Clavert P, Favard L, Chelli M (2019) Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities? J Shoulder Elb Surg 28(3):437–444. CrossRefGoogle Scholar
  24. 24.
    Attigah N, Oikonomou K, Hinz U, Knoch T, Demirel S, Verhoeven E, Bockler D (2016) Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms. J Vasc Surg 63(1):198–203. CrossRefPubMedGoogle Scholar
  25. 25.
    Longo UG, Petrillo S, Berton A, Denaro V (2016) Reverse total shoulder arthroplasty for the management of fractures of the proximal humerus: a systematic review. Musculoskelet Surg 100(2):83–91. CrossRefPubMedGoogle Scholar
  26. 26.
    Denard PJ, Ladermann A (2016) Immediate versus delayed passive range of motion following total shoulder arthroplasty. J Shoulder Elb Surg 25(12):1918–1924. CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryDupuytren University HospitalLimoges CedexFrance

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