Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures Carlos García-Fernández*, Yaiza Lopiz, Belén Rizo, Laura Serrano-Mateo, Borja Alcobía-Díaz, Alberto Rodríguez-González, Fernando Marco Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain A R T I C L E I N F O Article history: Received 15 May 2018 Received in revised form 22 June 2018 Accepted 30 June 2018 Keywords: Reverse shoulder arthroplasty Failed proximal humeral fixation A B S T R A C T Background: This study evaluates the clinical outcomes in patients with proximal humerus fractures (PHF) treated with reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed fixation that have more than 5 years of follow-up. Materials and Methods: This is a retrospective study of 270 RTSA. The inclusion criteria for this study consisted of patients initially treated with either open reduction and plate fixation (ORIF) or fixation using an intramedullary nail (IMN), who were managed with a single-stage revision to a RTSA, and had a minimum of 24 months clinical and radiological follow-up. Six patients with failed fixation of displaced PHF were revised with RTSA. One patient was excluded from the study because she died. Five shoulders were reviewed for the purpose of this study. The patients were evaluated using Constant score, relative Constant score and visual analogue scale for pain. Results: The mean follow-up was 89 months (65–108). The mean absolute Constant score improved from 31, 81 to 44, 2 and the relative Constant score improved from 31,81% to 67,2%. Mean VAS improved from 6, 8 to 2. One patient rated their outcome excellent, 1 good, 1 satisfied and 2 poor. Conclusion: RTSA is an appropriate treatment as a revision surgery for failed fixation of PHF. Patients should be adequately warned that they will improve their function but may have complications following this salvage procedure. © 2018 Elsevier Ltd. All rights reserved. Introduction Proximal humerus fractures (PHF) are among the most common fractures in elderly people. [1] The surgical management of displaced PHF in this population is challenging because these injuries are usually combined with osteoporosis and multiple comorbidities [2]. Currently, there are many techniques of fixation of displaced PHF including close reduction and percutaneous pinning, open reduction and internal fixation (ORIF), intra- medullary nailing (IMN), hemiarthroplasty and reverse total shoulder arthroplasty (RTSA). [3–7] These methods have a high rate of post-operative complications and further surgery has ranged from 13% to 34%. [8–10] Poor surgical technique, comminution of the fracture, and osteoporosis are the main reasons for loss of fixation and the development of avascular necrosis of the humeral head, iatrogenic screw perforation, mal-union and nonunion [11]. These complications lead to loss of function and increased pain. The orthopedic surgeon has few available and effective options when fixation of PHF fails and includes removal and revision of the fixation, capsular release, arthrolysis and conversion to arthroplasty. RTSA can be a primary treatment option in acute PHF, with satisfactory outcomes reported. [12, 13] RTSA has become more popular for elderly patients with PHF because avoids the problems of anatomical tuberosi- ty consolidation and rotator cuff tears. RTSA have been used as a primary treatment option for symptomatic malunions and nonunions of PHF and failed hemiarthroplasty following displaced PHF [14, 15]. There are few studies evaluating the outcomes of RTSA for the treatment of failed internal fixation of a PHF. [12, 16–18] The purpose of this study was to assess clinical and radiological outcomes after RTSA as a revision procedure for failed fixation of displaced PHF. * Corresponding author at: Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, C/ Martín Lagos, s/n. 28040, Madrid, Spain. E-mail address: carlosgf1969@gmail.com (C. García-Fernández). https://doi.org/10.1016/j.injury.2018.06.042 0020-1383/© 2018 Elsevier Ltd. All rights reserved. Injury, Int. J. Care Injured 49S (2018) S22–S26 Contents lists available at ScienceDirect Injury journa l home page : www.e lsevier.com/loca te/injury