{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:58:41Z","timestamp":1774911521393,"version":"3.50.1"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Due to the distinctive heterogeneity of the functional and biomechanical effects of\n        posttraumatic fracture sequelae subsequent to proximal humerus fractures, there are no\n        validated therapy guidelines yet and the majority of existing studies have concentrated on\n        endoprosthetic treatment options. This retrospective clinical study which directly compares\n        the functional outcome of patients after corrective osteotomy and osteosynthesis with that\n        of patients treated with reverse total shoulder arthroplasty was therefore needed to\n        demonstrate that the functional outcome after joint-preserving treatment provides better\n        results, as shown by the Constant score and range of motion, and identifies the specific\n        criteria relevant for treatment decision-making with a focus on joint preservation.<\/jats:p>\n                  <jats:p>Clinical follow-up examinations were performed after the respective revision surgeries\n        and information was collected about patients\u2019 postoperative status (e.\u2009g. rating scale for\n        pain, range of motion). Postoperative function was evaluated and analyzed using standardized\n        shoulder scores (Constant score, Simple Shoulder Test, Subjective Shoulder Value).<\/jats:p>\n                  <jats:p>A total of 29 patients were enrolled, with 11 receiving joint-preserving treatment\n        (group A) and 18 treated with arthroplasty (group B). Follow-up examinations were carried\n        out at 38.3\u2009\u00b1\u200930.2 months after revision surgery. In addition to the higher satisfaction\n        level in group A, lower levels of pain, and a higher range of motion, the Constant score\n        (71.4\u2009\u00b1\u200911.6 points vs. 54.1\u2009\u00b1\u200915.3 points, p\u2009=\u20090.008), the Simple Shoulder Test\n        (80.3\u2009\u00b1\u200916.8\u200a% vs. 54.6\u2009\u00b1\u200928.3\u200a%, p\u2009=\u20090.011) and the Subjective Shoulder Value\n        (75.5\u2009\u00b1\u200915.4\u200a% vs. 58.1\u2009\u00b1\u200920.9\u200a%, p\u2009=\u20090.021) each demonstrated significantly better results\n        for group A.<\/jats:p>\n                  <jats:p>These findings showed better clinical outcomes after joint-preserving therapy, which\n        suggests that it is the better treatment option. Patients &lt;\u200960 years of age with good\n        bone quality, intact rotator cuff muscles, and a respective patient individually functional\n        entitlement benefit from a joint-preserving approach, which should consequently be the\n        preferred treatment option. For patients &gt;\u200960 years of age, however, secondary\n        endoprosthetic treatment of fracture sequelae is still indicated, due to progressively\n        degenerative lesions of the rotator cuff muscles and\/or of the glenohumeral joint itself in\n        this age group.<\/jats:p>","DOI":"10.1055\/a-2740-3086","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:21:47Z","timestamp":1768436507000},"page":"151-160","source":"Crossref","is-referenced-by-count":0,"title":["Fracture Sequelae after Proximal Humerus Fractures \u2013 Clinical Outcome of Joint-Preserving Corrective Osteotomy versus Reverse Total Shoulder Arthroplasty"],"prefix":"10.1055","volume":"164","author":[{"given":"Maren","family":"Bieling","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, DIAKOVERE Friederikenstift Hospital Hannover, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freya","family":"Reeh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, DIAKOVERE Friederikenstift Hospital Hannover, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasobh","family":"Theruvath","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, DIAKOVERE Friederikenstift Hospital Hannover, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Sehmisch","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmut","family":"Lill","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, DIAKOVERE Friederikenstift Hospital Hannover, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Ellwein","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, DIAKOVERE Friederikenstift Hospital Hannover, Hannover, Germany"},{"name":"Department of Trauma Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"issue":"S 1","key":"ref1","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.otsr.2012.11.006","article-title":"Malunion of the proximal humerus","volume":"99","author":"F Duparc","year":"2013","journal-title":"Orthop Traumatol Surg Res"},{"issue":"S 5","key":"ref2","doi-asserted-by":"publisher","first-page":"S461","DOI":"10.1007\/s10039-016-0169-y","article-title":"Posttraumatische Korrekturen und Revisionen bei proximaler\n          Humerusfraktur","volume":"18","author":"JC Katthagen","year":"2016","journal-title":"Trauma Berufskrankh"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1067\/mse.2002.123902","article-title":"Proximal humeral malunions","volume":"31","author":"JA Siegel","year":"2000","journal-title":"Orthop Clin North Am"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1055\/a-0974-3887","article-title":"Corrective osteosynthesis in failed proximal humeral fractures.\n          Korrekturm\u00f6glichkeiten bei fehlgeschlagener Osteosynthese \u2013 proximaler Humerus","volume":"158","author":"RO Dey Hazra","year":"2020","journal-title":"Z Orthop Unfall"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"491","DOI":"10.5435\/JAAOS-22-08-491","article-title":"Management of malunion of the proximal humerus: current concepts","volume":"22","author":"D Pinkas","year":"2014","journal-title":"J Am Acad Orthop Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/01.blo.0000195679.87258.6e","article-title":"Proximal humerus fracture sequelae. Impact of a new radiographic classification on\n          arthroplasty","volume":"442","author":"P Boileau","year":"2006","journal-title":"Clin Orthop Relat Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1067\/mse.2001.115985","article-title":"Shoulder arthroplasty for the treatment of the sequelae of fractures of the\n          proximal humerus","volume":"10","author":"P Boileau","year":"2001","journal-title":"J Shoulder Elbow Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s00113-015-0032-9","article-title":"Posttraumatische Fehlstellungen und Pseudarthrosen des proximalen Humerus.\n          M\u00f6glichkeiten und Grenzen der Korrekturosteotomie","volume":"118","author":"R Meller","year":"2015","journal-title":"Unfallchirurg"},{"key":"ref9","first-page":"148","article-title":"Korrektureingriffe infolge von Humeruskopffrakturen","volume":"21","author":"P Habermeyer","year":"1992","journal-title":"Orthopade"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s00113-014-2682-4","article-title":"Korrekturosteosynthesen proximaler Humerusfrakturen. 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High bone consolidation rates after humeral head preserving\n          revision surgery in non-unions of the proximal humerus","volume":"152","author":"SD Aytac","year":"2014","journal-title":"Z Orthop Unfall"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.jse.2007.06.022","article-title":"A review of the Constant score: modifications and guidelines for its\n          use","volume":"17","author":"CR Constant","year":"2008","journal-title":"J Shoulder Elbow Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.jse.2004.10.009","article-title":"Normalization of the Constant score","volume":"14","author":"LI Katolik","year":"2005","journal-title":"J\u00a0Shoulder Elbow Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"413","DOI":"10.2519\/jospt.2010.3209","article-title":"The simple shoulder test is responsive in assessing change following shoulder\n          arthroplasty","volume":"40","author":"JS Roy","year":"2010","journal-title":"J Orthop Sports Phys"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.jse.2007.02.123","article-title":"Comparison of the subjective shoulder value and the Constant score","volume":"16","author":"MK Gilbart","year":"2007","journal-title":"J Shoulder Elbow Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1016\/j.jse.2015.12.002","article-title":"Outcomes of reverse shoulder arthroplasty as primary versus revision procedure for\n          proximal humerus fractures","volume":"25","author":"B Dezfuli","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jse.2016.05.020","article-title":"Reverse total shoulder arthroplasty for failed open reduction and internal\n          fixation of fractures of the proximal humerus","volume":"26","author":"F Grubhofer","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1053\/j.sart.2020.06.005","article-title":"Outcomes for reverse total shoulder arthroplasty after failed open reduction\n          internal fixation versus primary reverse total shoulder arthroplasty for proximal humerus\n          fractures","volume":"30","author":"N Linkous","year":"2020","journal-title":"Seminars in Arthroplasty: JSES"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2040","DOI":"10.1016\/j.jse.2016.04.038","article-title":"Three-dimensional corrective osteotomies of complex malunited humeral fractures\n          using patient-specific guides","volume":"25","author":"L Vlachopoulos","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1302\/0301-620X.77B2.7706351","article-title":"Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and\n          gender","volume":"77","author":"C Milgrom","year":"1995","journal-title":"J Bone Joint Surg Br"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1016\/j.jse.2010.12.006","article-title":"Proximal humeral fractures in younger patients: fixation techniques and\n          arthroplasty","volume":"20 (2 Suppl.)","author":"P Boileau","year":"2011","journal-title":"J Shoulder Elbow Surg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s00113-021-00956-1","article-title":"Posttraumatische Schultersteife","volume":"124","author":"JC Katthagen","year":"2021","journal-title":"Unfallchirurg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s00132-012-2024-6","article-title":"Inverse Schulterprothetik bei Frakturfolgezust\u00e4nden","volume":"42","author":"C Gwinner","year":"2013","journal-title":"Orthopade"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s00776-011-0185-5","article-title":"The use of the Lima reverse shoulder arthroplasty for the treatment of fracture\n          sequelae of the proximal humerus","volume":"17","author":"AA Martinez","year":"2012","journal-title":"J Orthop Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"417","DOI":"10.3944\/AOTT.2010.2272","article-title":"Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral\n          head","volume":"44","author":"M Kili\u00e7","year":"2010","journal-title":"Acta Orthop Traumatol Turc"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1302\/0301-620X.101B10.BJJ-2019-0142.R2","article-title":"A higher reoperation rate following arthroplasty for failed fixation versus\n          primary arthroplasty for the treatment of proximal humeral fractures: a retrospective\n          population-based study","volume":"101-B","author":"LL Nowak","year":"2019","journal-title":"Bone Joint J"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s11678-020-00559-z","article-title":"Outcomes and revision rates of primary versus secondary reverse total shoulder\n          arthroplasty for proximal humeral fractures","volume":"15","author":"JC Katthagen","year":"2020","journal-title":"Obere Extremit\u00e4t"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.1097\/CORR.0000000000001776","article-title":"In-hospital complications are more likely to occur after reverse shoulder\n          arthroplasty than after locked plating for proximal humeral fractures","volume":"479","author":"J K\u00f6ppe","year":"2021","journal-title":"Clin Orthop Relat Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.jse.2014.02.019","article-title":"Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients\n          65 years of age or younger","volume":"23","author":"EM Black","year":"2014","journal-title":"J\u00a0Shoulder Elbow Surg"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.jse.2016.09.051","article-title":"Reverse shoulder arthroplasty in patients younger than 55 years: 2- to 12-year\n          follow-up","volume":"26","author":"RJ Otto","year":"2017","journal-title":"J Shoulder Elbow Surg"}],"container-title":["Zeitschrift f\u00fcr Orthop\u00e4die und Unfallchirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2740-3086.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:33:39Z","timestamp":1774910019000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2740-3086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":30,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,3,30]]},"published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2740-3086","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1864-6697","1864-6743"],"issn-type":[{"value":"1864-6697","type":"print"},{"value":"1864-6743","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]}}}