[Differential indication of anatomic and reversed shoulder prostheses in fracture sequelae]

Results of shoulder replacement in fracture sequelae are not satisfying. This is due to an insufficient function of the rotator cuff, mostly because of a secondary necrosis of the tubercles. The aim of this study was to investigate if the differentiated use of anatomic and reversed prostheses in dependence of the preoperative anatomic situation is able to optimise the results.

The aim of this study was a comparison of 55 patients with secondary trauma prostheses in fracture sequelae. In 36 cases (especially fracture sequelae types 1 and 2 according to Boileau), anatomic head prostheses (Affinis, FU 24 months) and in 19 cases (especially fracture sequelae types 3 and 4 according to Boileau), inversed prostheses (Delta III, FU 18.3 months) were implanted.

The Constant score of the patients with fracture sequelae types 1 and 2 according to Boileau and Walch improved from 19 to 68 on average (anatomic prosthesis), and for types 3 and 4 from 9 to 47.5 (inversed prosthesis). For these special indications, fracture sequelae types 3 and 4 show remarkably better results than those with an anatomic head prosthesis mentioned in literature. The preoperative score of the collective of patients we examined was 10 points less than the one in comparable publications. The postoperative improvement is therefore clearly more significant.

The differentiated indication of anatomic and reversed shoulder prostheses in fracture sequelae leads to a noticeable improvement of the postoperative results. In slight malformations (fracture sequelae types 1 and 2) the anatomic prosthesis is the better choice. For severe deformations (fracture sequelae types 3 and 4) however, the implantation of a reversed prosthesis is the more convincing intervention. Moreover, the differentiated indication allows for a better prediction of the expected result.