059. Fractures complexes de l’extrémité supérieure de l’humérus traitées par prothèse inversée : influence des scores SF 36 et DASH pré-opératoires sur le résultat fonctionnel à 2 ans. - Comminutives proximal end of the humerus fractures treat by shoulder reverse arthroplasty. Results of SF36 and DASH pre-op scores on finctionnal results at 2yFUS

S El-Saïr, L. Labattut, E. Baulot (Dijon)

Introduction: The aim of our prospective study was evaluate the relationship between the SF-36 and DASH preoperative scores and final Constant score, in elderly people traited  by a reverse shoulder prothesis for complex humeral proximal fractures.

Furthermore Specific attention was paid to the attitude to adopt about tuberosity osteosynthesis.

Material and Methods:  Between November 2011 and June 2012, 30 shoulders in 30 patients (80% women) had been operated by reverse shoulder prosthesis for three or four fragments fracture, on two differents hospitals. It is a homogeneous series, using the same implant with the same superolateral surgical approach. The average follow-up was 24 months. The average age of the population was 78.8 years. One patient died, not reviewed at 2 years.

Results: Preoperatively: the average score Short-Form (SF) 36 mental was 68 and Physical was 67.9, the average DASH was  33.27.

At 6 months: the average Constant score was 52.6 (pain item 14.3/15);  at 12 months  it was 57.9 (pain item 14.6/ 15) and at 24 months it was 58.2 (item pain 14.8 / 15).

At one year, the average SF-36 mental score was 64.4, physics 59.4 and the average DASH 39.3.

At two years, the average DASH was 39.7. We observed this average amplitudes: 100.8 ° for the forward flexion, 86 ° abduction, for internal rotation inch in L3, and for external rotation elbow forward and hand on top of the head.

Radiologically: 11 scapula’s spurs, no implant migration, no peri prothesis osteolysis and no notching .

17% of complications: 4 dislocations (<3 months) 3 on glenoid 36 and one 40, all with a standard implant, traited successfully with a retentive polyethylene. One Propionibacterium acnes Sepsis controlled after washing, changing the friction torque and appropriate antibiotics.

Conclusion:There is a direct relationship between the preoperative scores SF36, DASH and clinical outcome.

To compare sets, the use of life quality scores pre and post operative is a very useful tool.

In elderly patients, the reverse shoulder artrhoplasty for complex proximal humeral fractures is a great option to obtain good clinical results.

The mechanical characteristics of the reverse shoulder prosthesis, facilitate the early rehabilitation. When the tuberosities ostosynthesis is not possible, it’s necessery to use a retentive polyethylene to decrease the risk of instability.

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