A multicenter retrospective study of 203 patients with proximal humerus fracture sequelae treated with nonconstrained shoulder arthroplasty, designed to validate Boileau's four-type surgical classification and determine which sequelae patterns yield predictable versus poor outcomes with standard unconstrained prostheses.
When you encounter a proximal humerus fracture sequela, classify it before booking the OR: if there is tuberosity-diaphysis continuity (Types 1 and 2), a nonconstrained prosthesis gives predictable results — accept the distorted anatomy and adapt the implant rather than osteotomizing.
If there is a surgical neck nonunion (Type 3) or severe tuberosity malunion (Type 4), a nonconstrained prosthesis is relatively contraindicated; redirect to peg bone graft with ORIF for Type 3 or reverse arthroplasty for Type 4.
A multicenter retrospective study of 203 patients with proximal humerus fracture sequelae treated with nonconstrained shoulder arthroplasty, designed to validate Boileau's four-type surgical classification and determine which sequelae patterns yield predictable versus poor outcomes with standard unconstrained prostheses.
When you encounter a proximal humerus fracture sequela, classify it before booking the OR: if there is tuberosity-diaphysis continuity (Types 1 and 2), a nonconstrained prosthesis gives predictable results — accept the distorted anatomy and adapt the implant rather than osteotomizing.
If there is a surgical neck nonunion (Type 3) or severe tuberosity malunion (Type 4), a nonconstrained prosthesis is relatively contraindicated; redirect to peg bone graft with ORIF for Type 3 or reverse arthroplasty for Type 4.