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Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures (PHFs) in the elderly. This study evaluates the influence of tuberosity healing (TH) on functional outcome following a 135° humeral inclination RSA for PHFs. Retrospectively, all patients with an acute PHF treated with a 135° humeral inclination RSA at four centers during a three-year period were followed up. Constant score (CS), TH and glenoid notching were analyzed. Sixty-four of 100 patients (64%) with a mean age of 76 ± 7 years were available for follow-up at 22 ± 8 months. The mean-adjusted CS was 72%. TH of the greater tuberosity (GT) was 77% and resulted in significantly improved forward flexion (128° vs. 92°; p = 0.003), external rotation (33° vs. 17°; p = 0.03) and adjusted CS (78% vs. 54%, p

The use of reverse total shoulder arthroplasty has increased for the management of cuff-deficient glenohumeral joint arthritis and fractures. With bone preservation being a major target in reverse shoulder arthroplasty, metaphyseal humeral components without a stem were developed. The aim of this study is to present the survivorship, functional and radiological outcomes of a novel short metaphyseal prosthesis without a diaphyseal stem from an independent centre. Clinical function and radiological features of patients undergoing stemless reverse shoulder arthroplasty were prospectively recorded. Patients’ demographics, indications for surgery, complications, functional and radiological assessment at the final follow-up as well as survivorship with the end point of revision for any reason were recorded. Between 2009 and 2016, 36 patients received 37 reverse shoulder arthroplasties with the stemless Verso prosthesis. Mean age of the patients was 76.9 years. The most common indication for surgery was cuff tear arthropathy. Mean follow-up was 3 years (range 1–7 years). Oxford shoulder score improved from an average of 11 pre-operatively (range 2–19) to 44 post-operatively (range 29–48) (p

The Delta III semi-constrained reverse-ball-and-socket total shoulder prosthesis works only with an intact deltoid muscle. Our purpose is to evaluate the results in a consecutive series of acute complex fractures of the proximal humerus in elderly population with a poor bone quality when the main problem is to obtain a reliable and efficient re-fixation of the tubercles with classical orthopaedic devices. From 1993 to 2005, 36 Delta III were implanted, 27 three-part, and four-part displacements and nine fracture-dislocations, in 3 males for 33 females, for 16 dominant sides, with an average age of 75 years. The surgery was realized under general anaesthesia, in semi-sitting position, by an antero-lateral approach with retroversion of the humeral-cemented stem of 20° to 0°. Post-operative physiotherapy was not always realizable. The results were estimated with the clinical Constant scoring system, AP and lateral view X-rays. Twenty-five cases were reviewed because nine were deceased and two moved out. At a mean follow-up of 71 months, the Constant score was 59 points for a contra-lateral shoulder evaluated at 81. The results were good in respect of pain (14.1), activity (14.3), strength (14.1), anterior elevation (7.5), abduction (6.5), but very poor for external (1.1), and internal (1.4) rotations. The radiographs showed: one aseptic glenoid loosening at 12-year follow-up with surgical revision, 14 inferior scapular notching (seven stages 1, five stages 2, one stage 3, one stage 4), 14 inferior spurs stable after emergence without clinical repercussion, four medial and two lateral proximal humeral bone loose, and two medial humeral lucent lines. For acute complex fractures of the proximal humerus, in elderly population with poor bone quality, when an efficient and reliable re-fixation of the tubercles is difficult or impossible, the Delta III prosthesis is a possible alternative with good functional outcome except rotations but with a lot of worrying inferior scapular notching.

The Grammont total shoulder prosthesis (Delta III) is an original reversed constrained prosthesis. Classical indication is glenohumeral osteoarthritis with massive and irreparable rotator cuff tears. The authors report a Delta III arthroplasty for a rare histological variant of proximal chondrosarcoma, by pointing out the technical and biomechanical principles of this arthroplasty. Clinical and radiological results are presented with a 9-year follow-up. To our mind, in case of malignant bony tumours of proximal humerus with carcinologic cuff resection, the Grammont total shoulder arthroplasty is of interest and its proposal must be discussed.

Purpose Revision surgery for shoulder prosthesis remains a difficult task in shoulder surgery. The purpose of this retrospective study was to evaluate the clinical and radiological outcomes of a series of 30 reverse shoulder prostheses performed as revision of failed hemi- or total shoulder arthroplasty. The most relevant technical points in surgery are described, as are other surgical options; a rational strategy for the treatment of these patients is proposed. Materials and methods Thirty patients (average age 69.5) were included. Mean follow-up was 36.4 months (range 24–100 months). There were 14 patients in group 1 (Delta III) and 16 in group 2 (Reverse Arrow). Results A total of 83 % were satisfied (16 cases) or very satisfied (9 cases), and 17 % were disappointed (5 patients). The mean Constant score increased from a mean of 25–52. The mean score for pain improved from 5 (range 0–15) to 13 (range 5–15) (p