Hamersly Jackson S, Tippy Mason D, Slaven James E, Jang Yohan, Ladd Lauren M, Dillon Mark T
Indiana University School of Medicine, Indianapolis, Indiana, United States.
Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, United States.
Arch Orthop Trauma Surg. 2025 Jul 15;145(1):375. doi: 10.1007/s00402-025-05977-8.
Glenoid morphology in patients undergoing reverse total shoulder arthroplasty (rTSA) due to arthritis has been previously studied; however, it has not been as thoroughly evaluated in fracture populations. The purpose of this study is to utilize pre-operative computed tomography (CT) scans to better understand the glenoid anatomy of those patients undergoing rTSA due to fracture.
Patients over the age of 18 who underwent rTSA for proximal humerus fractures from January 1, 2015 to October 31, 2023 at two university health system affiliated hospitals were included if they had a CT scan available for review and image reconstruction. Patients were excluded if a pathologic fracture was identified, surgery was performed greater than 6 weeks after the initial injury, surgery was a conversion or revision surgery, or if a glenoid fracture was present. Glenoid version and reverse shoulder arthroplasty (RSA) angles were measured by a musculoskeletal fellowship-trained radiologist and a shoulder and elbow fellowship-trained orthopaedic surgeon and averaged for final values. Glenoid morphologies were determined using the Walch and Favard classifications.
A total of 53 patients with a mean age of 70.4 years (range 36.6-91.2) were included in this study, 84.9% of which were female. Walch A1 glenoid morphology was noted in 92.5% of patients, and Favard E0 morphology was present in 98.1% of patients. Median glenoid version was 3° of retroversion. Median RSA angle was 19°. Of note, 37.7% of patients had a RSA angle of ≥ 20°.
Patients undergoing rTSA for fracture may not have significant glenoid deformity from arthritic wear. However, surgeons should be aware of variations in glenoid version and RSA angle. In this study population, over one-third of patients had a RSA angle of ≥ 20°. Thus, surgeons should take these findings into account when performing rTSA for fracture.
先前已对因关节炎接受反式全肩关节置换术（rTSA）患者的肩胛盂形态进行了研究；然而，在骨折患者群体中尚未得到如此全面的评估。本研究的目的是利用术前计算机断层扫描（CT）来更好地了解因骨折接受rTSA患者的肩胛盂解剖结构。
纳入2015年1月1日至2023年10月31日期间在两家大学健康系统附属医院因肱骨近端骨折接受rTSA且年龄在18岁以上的患者，条件是他们有可供复查和图像重建的CT扫描。如果确定为病理性骨折、初次受伤后超过6周进行手术、手术为转换或翻修手术，或存在肩胛盂骨折，则将患者排除。肩胛盂版本和反式肩关节置换术（RSA）角度由一名接受过肌肉骨骼专科培训的放射科医生和一名接受过肩肘专科培训的骨科医生测量，并取平均值作为最终值。使用Walch和Favard分类法确定肩胛盂形态。
本研究共纳入53例患者，平均年龄70.4岁（范围36.6 - 91.2岁），其中84.9%为女性。92.5%的患者表现为Walch A1肩胛盂形态，98.1%的患者存在Favard E0形态。肩胛盂版本中位数为后倾3°。RSA角度中位数为19°。值得注意的是，37.7%的患者RSA角度≥20°。
因骨折接受rTSA的患者可能没有因关节炎磨损导致的明显肩胛盂畸形。然而，外科医生应注意肩胛盂版本和RSA角度的变化。在本研究人群中，超过三分之一的患者RSA角度≥20°。因此，外科医生在为骨折患者进行rTSA时应考虑这些发现。
