ORTHOPAEDIC SURGERY Reconstruction techniques in comparison for reverse shoulder trauma prosthesis in the elderly: a follow-up between 2 and 4 years Raffaele Russo 1 • Fabio Cautiero 1 • Alberto Fontanarosa 2 • Giuseppe della Rotonda 3 • Giuliana Valerio 4 Received: 2 February 2015 Ó Springer-Verlag Berlin Heidelberg 2015 Abstract Introduction The aim of this study was to evaluate the clinical outcome of a bone graft technique called bCAT (bone Collar And Tie), in which the fractured humeral head is modelled into a collar shape versus puzzle piece recon- struction (PPR) in elderly patients with complex proximal humeral fractures. Materials and methods Between 2005 and 2011, we have performed 46 reverse shoulder prosthesis in patients with a mean age of 73.8 years (range 69–95) affected by shoulder complex fracture. A Delta CTA Depuy prosthesis was used in two patients, and a Lima SMR modular shoulder system in 44. To obtain a homogeneous group we compared the cases in which was used the same prosthesis with a similar follow-up. In a series of patients, we reconstructed tuberosities with the PPR technique (group A), while in another series we used the bCAT technique (group B). Results The results were evaluated in 20 of group A and 20 of group B patients (mean clinical and radiological follow-up: 45.8 months). Average range of motion in group A was 111° anterior elevation, 90° abduction, 16° extrarotation and intrarotation till the sacral bone. The corresponding values in group B were 150°, 110°, 44° and L4. The mean absolute and age-adjusted Constant-Murley score were 55 and 67.85 %, respectively, in group A and 70.8 and 83.85 % in group B. Tuberosity resorption oc- curred in 40 % of group A versus 15 % in group B. Conclusion The PPR and the bCAT techniques promoted the healing and correct positioning of the tuberosities thereby resulting in good functioning of the residual cuff. The bCAT technique resulted in better clinical function particularly in abduction and extrarotation and in terms of radiological outcome of reverse prosthesis surgery. Keywords Humeral fractures Á Reverse shoulder prosthesis Á Cemented and uncemented prosthesis Á Constant-Murley score Á Tuberosity position Á Cuff tension Introduction The surgical treatment of complex proximal humeral fractures remains controversial particularly in the elderly [1–13]. Although hemiarthroplasty has long been consid- ered the gold standard treatment, particularly in patients older than 65 years [1, 2, 4, 9, 12, 14–16], the functional outcome of endoprosthesis is not always satisfactory especially in the elderly due to poor bone stock quality, and in cases of insufficient cuff repair, muscle fatty degen- eration, tuberosity malunion or non-union, loss of tuber- osity reduction and consequent tuberosity resorption [2, 4, 6, 14, 17, 18]. Reverse prosthesis was proposed as a means to prevent complications due to tuberosity malunion or non-union and secondary cuff insufficiency [3, 10, 19–23]. Although this procedure results in adequate pain relief, the range of motion, particularly in terms of rotations, is lim- ited and tuberosity healing is not always achieved. & Fabio Cautiero fabiocau@inwind.it 1 Orthopaedic and Traumatology Department, Ospedale dei Pellegrini, Via Portamedina 41, 80134 Naples, Italy 2 Orthopaedic and Traumatology Unit, Ospedale Santa, Maria, Borgo Val di Taro, PR, Italy 3 Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK 4 Department of Movement Sciences and Wellness, Parthenope University of Naples, Naples, Italy 123 Arch Orthop Trauma Surg DOI 10.1007/s00402-015-2221-y