Differential indication of anatomic and reversed shoulder prostheses in fracture sequelae

Abstract ! Aim: Results of shoulder replacement in frac-ture sequelae are not satisfying. This is due toan insufficient function of the rotator cuff, most-ly because of a secondary necrosis of the tu-bercles. The aim of this study was to investi-gate if the differentiated use of anatomic and re-versed prostheses in dependence of the preoper-ative anatomic situation is able to optimise theresults. Method: The aim of this study was a compari-son of 55 patients with secondary trauma pros-theses in fracture sequelae. In 36 cases (espe-cially fracture sequelae types 1 and 2 accordingto Boileau), anatomic head prostheses (Affinis,FU 24 months) and in 19 cases (especially frac-turesequelaetypes3and4accordingtoBoileau),inversed prostheses (Delta III, FU 18.3 months)were implanted. Results: The Constant score of the patients withfracture sequelae types 1 and 2 according toBoileau and Walch improved from 19 to 68 onaverage (anatomic prosthesis), and for types 3and 4 from 9 to 47.5 (inversed prosthesis).For these special indications, fracture sequelaetypes 3 and 4 show remarkably better resultsthan those with an anatomic head prosthesismentioned in literature. The preoperative scoreof the collective of patients we examined was 10points less than the one in comparable publica-tions. The postoperative improvement is there-fore clearly more significant.