The Outcome of Total Reverse Shoulder Arthroplasty for Avascular Necrosis of The Humeral Head After Open Reduction and Internal Fixation of The Proximal Humerus

A Case Report

Abstract

 Background: The reverse total shoulder arthroplasty (RTSA) as a salvage procedure in avascular necrosis of the humeral head (AVNHH) after open reduction internal fixation (ORIF) becomes a challenging management of proximal humerus fracture (PHF). However, the functional outcomes and complication managements are still debatable. This report aims to provide the outcomes of RSTA as a salvage procedure on AVNHH post internal
fixation.
Case report: A 68-year-old man was admitted to the orthopaedic outpatient clinic with shoulder pain and limitations doing daily activities such as combing his hair, putting on clothes, and raising his right hand up. He has a history of ORIF of the proximal humerus caused by PHF two years earlier. The clinical examination showed no swelling in the right shoulder with a past operation scar on the anterior of the shoulder. We observed a slight bulging in the tip of the shoulder during shoulder abduction. The radiological examination showed a loss of fixation of the head of the humerus with degenerated humeral head. The patient underwent RTSA under general anaesthesia. Post-operative evaluation 2 years after surgery showed acceptable results.
Conclusions: A thorough functional evaluation after the ORIF procedure in PHF with high potential vascular injury should be done continuously in order to avoid avascular necrosis complications and to determine the decision of RTSA as a salvage procedure.
Keywords: avascular necrosis, proximal humeral head, reverse total shoulder arthroplasty, post-internal fixation complication