• Raffaele Russo, Fabio Cautiero, Alberto Fontanarosa, Giuseppe della Rotonda, and Giuliana Valerio.
• Orthopaedic and Traumatology Department, Ospedale dei Pellegrini, Via Portamedina 41, 80134, Naples, Italy.
• Arch Orthop Trauma Surg. 2015 Jul 1; 135 (7): 905912905-12.

IntroductionThe aim of this study was to evaluate the clinical outcome of a bone graft technique called bCAT (bone Collar And Tie), in which the fractured humeral head is modelled into a collar shape versus puzzle piece reconstruction (PPR) in elderly patients with complex proximal humeral fractures.Materials And MethodsBetween 2005 and 2011, we have performed 46 reverse shoulder prosthesis in patients with a mean age of 73.8 years (range 69-95) affected by shoulder complex fracture. A Delta CTA Depuy prosthesis was used in two patients, and a Lima SMR modular shoulder system in 44. To obtain a homogeneous group we compared the cases in which was used the same prosthesis with a similar follow-up. In a series of patients, we reconstructed tuberosities with the PPR technique (group A), while in another series we used the bCAT technique (group B).ResultsThe results were evaluated in 20 of group A and 20 of group B patients (mean clinical and radiological follow-up: 45.8 months). Average range of motion in group A was 111° anterior elevation, 90° abduction, 16° extrarotation and intrarotation till the sacral bone. The corresponding values in group B were 150°, 110°, 44° and L4. The mean absolute and age-adjusted Constant-Murley score were 55 and 67.85 %, respectively, in group A and 70.8 and 83.85 % in group B. Tuberosity resorption occurred in 40 % of group A versus 15 % in group B.ConclusionThe PPR and the bCAT techniques promoted the healing and correct positioning of the tuberosities thereby resulting in good functioning of the residual cuff. The bCAT technique resulted in better clinical function particularly in abduction and extrarotation and in terms of radiological outcome of reverse prosthesis surgery.

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