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Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?

BACKGROUND: Implantation rates of reverse total shoulder arthroplasties continue to grow worldwide. Despite satisfying results, a distinct number of complications persist. Intraoperative fractures of the humeral shaft might occur in a certain number of cases. The literature is sparse regarding incid...

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Autores principales: Kriechling, Philipp, Hasler, Anita, Passaplan, Caroline, Wieser, Karl
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245986/
https://www.ncbi.nlm.nih.gov/pubmed/34223414
http://dx.doi.org/10.1016/j.jseint.2021.03.008
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author Kriechling, Philipp
Hasler, Anita
Passaplan, Caroline
Wieser, Karl
author_facet Kriechling, Philipp
Hasler, Anita
Passaplan, Caroline
Wieser, Karl
author_sort Kriechling, Philipp
collection PubMed
description BACKGROUND: Implantation rates of reverse total shoulder arthroplasties continue to grow worldwide. Despite satisfying results, a distinct number of complications persist. Intraoperative fractures of the humeral shaft might occur in a certain number of cases. The literature is sparse regarding incidence and treatment options. This study analyzed the treatment using suture cerclage or stainless-steel-cable cerclage. METHODS: Our prospectively followed-up cohort of 860 patients who received primary reverse total shoulder arthroplasty in a tertiary referral hospital between September 2005 and August 2018 was screened for intraoperative medial humeral calcar fractures. The patients were retrospectively analyzed as per the treatment algorithm using (1) suture cerclage with FiberWire, (2) cable cerclage with stainless steel cable, or (3) no intervention. The outcome was radiologically and clinically (Subjective Shoulder Value and Constant score) evaluated. RESULTS: A total of 39 (4.5%) intraoperative calcar fractures of the humeral shaft were identified with 29 cases available for analysis at a mean follow-up time of 52 ± 27 months. Sixteen of them were treated with suture cerclage, 7 with metal cable cerclage, and 6 without intervention. All fractures were nondisplaced or could be reduced anatomically and healed without any stem subsidence or loosening within the first 4.5 months. The intervention groups reached similar values for the Subjective Shoulder Value (68%±27% vs. 79%±19%, suture vs. cable) and relative Constant score (65 % ± 25 % vs. 75 % ± 23). CONCLUSION: Intraoperative medial calcar fractures can be sufficiently treated with metal or suture cerclage fixation. High-strength polyblend-polyethylene sutures seem to be a valid therapeutic option for selected medial calcar fractures of the humerus. In selected cases, however, benign neglect can result in excellent results as well.
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spelling pubmed-82459862021-07-02 Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties? Kriechling, Philipp Hasler, Anita Passaplan, Caroline Wieser, Karl JSES Int Shoulder BACKGROUND: Implantation rates of reverse total shoulder arthroplasties continue to grow worldwide. Despite satisfying results, a distinct number of complications persist. Intraoperative fractures of the humeral shaft might occur in a certain number of cases. The literature is sparse regarding incidence and treatment options. This study analyzed the treatment using suture cerclage or stainless-steel-cable cerclage. METHODS: Our prospectively followed-up cohort of 860 patients who received primary reverse total shoulder arthroplasty in a tertiary referral hospital between September 2005 and August 2018 was screened for intraoperative medial humeral calcar fractures. The patients were retrospectively analyzed as per the treatment algorithm using (1) suture cerclage with FiberWire, (2) cable cerclage with stainless steel cable, or (3) no intervention. The outcome was radiologically and clinically (Subjective Shoulder Value and Constant score) evaluated. RESULTS: A total of 39 (4.5%) intraoperative calcar fractures of the humeral shaft were identified with 29 cases available for analysis at a mean follow-up time of 52 ± 27 months. Sixteen of them were treated with suture cerclage, 7 with metal cable cerclage, and 6 without intervention. All fractures were nondisplaced or could be reduced anatomically and healed without any stem subsidence or loosening within the first 4.5 months. The intervention groups reached similar values for the Subjective Shoulder Value (68%±27% vs. 79%±19%, suture vs. cable) and relative Constant score (65 % ± 25 % vs. 75 % ± 23). CONCLUSION: Intraoperative medial calcar fractures can be sufficiently treated with metal or suture cerclage fixation. High-strength polyblend-polyethylene sutures seem to be a valid therapeutic option for selected medial calcar fractures of the humerus. In selected cases, however, benign neglect can result in excellent results as well. Elsevier 2021-04-24 /pmc/articles/PMC8245986/ /pubmed/34223414 http://dx.doi.org/10.1016/j.jseint.2021.03.008 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Shoulder
Kriechling, Philipp
Hasler, Anita
Passaplan, Caroline
Wieser, Karl
Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
title Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
title_full Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
title_fullStr Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
title_full_unstemmed Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
title_short Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
title_sort is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties?
topic Shoulder
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245986/
https://www.ncbi.nlm.nih.gov/pubmed/34223414
http://dx.doi.org/10.1016/j.jseint.2021.03.008
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