Presentation
Pain over right shoulder post fall. Post-operative reverse total shoulder arthroplasty performed 1 month after initial presentation.
Patient Data
There are displaced fractures involving the greater tuberosity and surgical neck of the humerus, with possible anterior subluxation of the humeral head.
No dislocation is noted, with the acromioclavicular joint appearing congruent. Diffuse bony osteopenia and a prominent subacromial spur is also observed.
A reverse total shoulder arthroplasty has been performed, with no periprosthetic lucency or fracture demonstrated.
Case Discussion
In this case, the patient had sustained displaced fractures involving multiple regions of the humerus. Initial plans for conservative management were changed after the fractures were malunited on the 1-month follow up imaging, showing valgus displacement 1 with a humeral neck-shaft angle of 180°. Of note as well, was the patient's pre-existing full-thickness large supraspinatus tear and long head of biceps tendon rupture.
A reverse total shoulder arthroplasty was hence performed due to the advanced damage to the rotator cuff.
Implant position, fragment position and fracture healing can be evaluated with a:
- Grashey view
- axillary radiograph (often performed as a Velpeau view or a modified trauma axial view of the shoulder)
Radiographers performing post-operative imaging for such patients should ideally ensure that the entire length of the implant can be assessed in a single image, including the cemented tip.
Post-operative notes on the implant used:
- DePuy Synthes DELTA XTEND™
- 38mm Glenosphere
- cemented stem size 8
- standard +6 polyethylene
Disclaimer:
I, Amanda Er, have no actual or potential ethical or financial conflict of interest in relation to the aforementioned device. This case is not intended to be a personal endorsement or recommendation of these products.
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