Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium.The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).Methods This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: two years, minimum age: 60 years).The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05 and 95% confidence intervals).Results Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p = .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.Conclusions RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.Trial RegistrationNot applicable, level of evidence III.
Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, including patients with poor bone quality, has significantly extended the surgical armamentarium.The aim of this study was to investigate the mid-term outcome following fracture RSA (FRSA) in acute or sequelae, as well as salvage procedures. It was hypothesized that revision FRSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).Methods This retrospective case-series study describes the radiological and clinical mid-term outcome in a standardized single-center and one-material Inlay design. Patients who underwent FRSA between 2008 and 2017 were matched (minimum follow-up: two years, minimum age at the time of operation: 60 years).The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, Quick DASH, and Subjective Shoulder Value. All adverse events and the radiological results and their clinical correlations were analyzed statistically (using α = 5% and 95% confidence intervals).Results Following FRSA, 68 patients were included (mean age: 72.5 years, mean FU: 46 months). Forty-two underwent primary RSA (PRSA), 26 revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).No statistically significant results were found in PRSA and SRSA in effect sizes by scores, whereby the failed osteosynthesis SRSA subgroup obtained significantly negative values in ROM subzones (flexion: p = .046, abduction: p = .037). Decreased tubercle healings in PRSA relative to SRSA were observed (p = .006). A missing bony healing of the tubercles was related to significant negative clinical outcome (all scores: p < .05, external rotation: p = .019). In SRSA, significant postoperative improvements could be stated (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.Conclusions RSA is an effective option in severe shoulder fracture management with predictable results as salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and a high patient satisfaction could be achieved.Trial RegistrationNot applicable, level of evidence III.
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