Purpose
To report the mid- to long-term results of arthroscopic tuberoplasty and rotator cuff
retensioning for proximal humerus malunion.
Methods
Between August 2001 and October 2009, 9 patients with a mean age of 49 years underwent
shoulder arthroscopy with tuberoplasty and rotator cuff advancement for malunion of
the proximal humerus and were included in this study. The mean delay between the initial
fracture and our surgery was 19 months. We developed a systematic technique to take
down the rotator cuff over the malunited proximal humerus, perform a tuberoplasty,
and then retension and repair the rotator cuff by advancing it on the greater tuberosity.
The mean follow-up was 50 months (range, 12 to 108 months).
Results
Patients showed mean active forward elevation of 164° (range, 90° to 180°; gain of
43°), recovery of mean active external rotation of 45° (range, 30° to 60°; gain of
16°), and a mean pain score of 1.8 points (range, 0 to 5 points; reduction of 3.8
points). The overall functional results according to the University of California,
Los Angeles score were excellent in 3 cases, good in 3, and fair in 3. No patient
required additional surgery. Of the 9 patients, 8 (89%) were able to return to their
previous sports or activities. All patients declared themselves as being satisfied
with the result.
Conclusions
Arthroscopic tuberoplasty and rotator cuff retensioning for proximal humerus malunion
comprise a viable alternative to traditional open methods, particularly in young patients.
A comprehensive approach is recommended that addresses stiffness, associated pathology,
and impingement, and re-establishes rotator cuff function. Although the technique
is technically demanding, it allows preservation of the native humeral head, is associated
with a very low complication rate, and avoids concerns about long-term prosthetic
survival in young patients.
Level of Evidence
Level IV, therapeutic case series.
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References
- Complications of internal fixation of proximal humeral fractures.Instr Course Lect. 1997; 46: 25-37
- Open reduction and internal fixation of greater tuberosity fractures, malunions and nonunions.in: Craig E. Master techniques in orthopaedic surgery: The shoulder. Raven, New York1995: 289-307
- Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.J Bone Joint Surg Am. 1991; 73: 1213-1218
- Malunions of the proximal humerus.in: Warner J. Iannotti J. Gerber C. Complex and revision problems in shoulder surgery. Lippincott-Raven, Philadelphia1997: 245-264
- Fractures of the upper end of the humerus.Clin Orthop. 1961; 20: 73-93
- Die lange und dle spannung des muskels.Skand Arch Physiol. 1891; 3: 295-318
- Biomechanical comparison of effects of supraspinatus tendon detachments, tendon defects, and muscle retractions.J Bone Joint Surg Am. 2002; 84: 780-785
- The action of the short rotator on the normal abduction of the arm, with a consideration of their action in some cases of subacromial bursitis and allied conditions.Am J Med Sci. 1909; 138: 870-884
- Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus.J Shoulder Elbow Surg. 2001; 10: 299-308
- Arthroscopic subscapularis tenolysis: A technique for treating refractory glenohumeral stiffness following open reduction and internal fixation of a displaced three-part proximal humerus fracture.Arthroscopy. 1996; 12: 87-91
- Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture.Arthroscopy. 2000; 16: 695-700
- Operative treatment of malunion of a fracture of the proximal aspect of the humerus.J Bone Joint Surg Am. 1998; 80: 1484-1497
- Arthroscopic tuberoplasty for subacromial impingement secondary to proximal humeral malunion.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 988-991
- Articular impingement in malunited fracture of the humeral head.Arthroscopy. 2002; 18: E39
- Repair of the rotator cuff.J Bone Joint Surg Am. 1986; 68: 1136-1144
- American Shoulder and Elbow Surgeons standardized shoulder assessment form, patient self-report section: Reliability, validity, and responsiveness.J Shoulder Elbow Surg. 2002; 11: 587-594
- Arthroscopic subacromial decompression: Analysis of one- to three-year results.Arthroscopy. 1987; 3: 173-181
- Assessment of shoulder range of motion: Introduction of a novel patient self-assessment tool.Arthroscopy. 2008; 24: 712-717
- Comparison of self-administered University of California, Los Angeles, shoulder score with traditional University of California, Los Angeles, shoulder score completed by clinicians in assessing the outcome of rotator cuff surgery.J Shoulder Elbow Surg. 2008; 17: 564-569
- Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales.Am J Sports Med. 1999; 27: 214-221
- Displaced proximal humeral fractures.J Bone Joint Surg Am. 1970; 52: 1077-1089
- The morphology of the acromion and its relationship to rotator cuff tears.Orthop Trans. 1986; 10: 216
- Comminuted fractures of the proximal humerus.Clin Orthop Relat Res. 1988; : 49-57
- Displaced proximal humeral fractures.J Bone Joint Surg Am. 1970; 52: 1090-1103
- Proximal humerus malunions.Orthop Clin North Am. 2000; 31: 35-50
- Old trauma in glenohumeral arthroplasty.in: Shoulder reconstruction. WB Saunders, Philadelphia1990: 222-234
- Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures.J Shoulder Elbow Surg. 1995; 4: 271-280
- Proximal humerus fracture sequelae: Impact of a new radiographic classification on arthroplasty.Clin Orthop Relat Res. 2006; 442: 121-130
- Neer Award 2005: The Grammont reverse shoulder prosthesis: Results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.J Shoulder Elbow Surg. 2005; 2006: 527-540
- Reverse total shoulder arthroplasty: A review of results according to etiology.J Bone Joint Surg Am. 2007; 89: 1476-1485
- Arthroscopic capsular release after hemiarthroplasty of the shoulder for fracture: A new treatment paradigm.Arthroscopy. 2005; 21: 1150.e1-1150.e5
- Arthroscopic capsular release for posttraumatic shoulder stiffness.J Shoulder Elbow Surg. 2008; 17: 410-414
- Arthroscopic capsular release for stiff shoulders: Effect of etiology on outcomes.Arthroscopy. 2003; 19: 40-49
- Management of proximal humeral nonunions and malunions.Orthop Clin North Am. 2008; 39: 475-482
- The tendon of the long head of the biceps in complex proximal humerus fractures: A histological perspective.Injury. 2010; 41: 273-278
Article info
Publication history
Published online: March 12, 2012
Accepted:
December 13,
2011
Received:
February 19,
2011
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
