Acute versus delayed reverse total shoulder arthroplasty for the treatment of proximal humeral fractures in the elderly population: a systematic review and meta-analysis

Torchia, Michael T.; Austin, Daniel C.; Cozzolino, Niki H; Jacobowitz, Lauren; Bell, John‐Erik

doi:10.1016/j.jse.2018.10.004

Cited by 52 publications

(50 citation statements)

References 42 publications

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“…Anterior elevation was improved in the RTSA group compared with the non-operative group (110°versus 98°); however, there were more complications in the RTSA group (7% versus 0%) [85]. Furthermore, delayed primary RTSA compared with acute primary RTSA yielded similar clinical results and reoperation rates, suggesting that perhaps in this frail population a trial of non-operative management may be prudent when appropriate [86].…”

Section: Proximal Humerus Fracturesmentioning

confidence: 85%

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

Rugg

Coughlan

Lansdown

2019

Curr Rev Musculoskelet Med

101

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Purpose of Review Over the past decade, our understanding of the biomechanics of the reverse total shoulder arthroplasty (RTSA) has advanced, resulting in design adjustments, improved outcomes, and expanding indications. The purpose of this review is to summarize recent literature regarding the biomechanics of RTSA and the evolving indications for its use. Recent Findings While Grammont's principles of RTSA biomechanics remain pillars of contemporary designs, a number of modifications have been proposed and trialed in later generations to address complications such as impingement and glenoid failure. Clinical and biomechanical literature suggest that less medialized, more inferior glenospheres result in less impingement and notching. On the humerus, a more vertical neck cut is associated with less impingement. Indications for RTSA continue to expand beyond the classic indication of cuff tear arthropathy (CTA). Patients without a functional cuff but no arthritis now have a reliable option in the RTSA. RTSA has also replaced hemiarthroplasty as the implant of choice for displaced three-and four-part proximal humerus fractures in the elderly. Finally, updated design options and modular components now allow for treatment of glenoid bone loss, failed arthroplasty, and proximal humerus tumors with RTSA implants. Summary Reverse total shoulder arthroplasty design has been modernized on both the glenoid and humerus to address biomechanical challenges of early implants. As outcomes improve with these modifications, RTSA indications are growing to address complex bony pathologies such as tumor and bone loss. Longitudinal follow-up of patients with updated designs and novel indications is essential to judicious application of RTSA technology.

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Section: Proximal Humerus Fracturesmentioning

confidence: 85%

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

Rugg

Coughlan

Lansdown

2019

Curr Rev Musculoskelet Med

101

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“…It is reasonable in a polytrauma patient at high risk for surgery to attempt a trial of nonoperative management followed by late rTSA if nonoperative management fails; these delayed rTSAs have been shown to have no difference in forward flexion, clinical outcome, or all-cause reoperation. 56 In fact, the delayed group in the study had significantly better external rotation than the acute group. Another study compared acute rTSA versus rTSA to salvage failed ORIF.…”

Section: Managementmentioning

confidence: 78%

High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review

Walters

Ahmadi

2020

Geriatr Orthop Surg Rehabil

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High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.

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“…RSA is additionally associated with a higher rate of postoperative complications than hemiarthroplasty [ 13 ]. There is no difference in clinical outcome scores, forward flexion or risk of reoperation between acute RSA and delayed RSA [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic migration of a K-wire after percutaneous fixation of a proximal humerus fracture.

Hasselt

Hooghof

Huizinga

et al. 2021

Trauma Case Reports

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Proximal humerus fractures are common in elderly patients. Not all patient are fit for major surgery. Percutaneous fixation can be a suitable option though surgeons should be aware of the risks and complications. This case is about a 90-year-old woman with a proximal humerus fracture. After closed anatomical reduction we performed percutaneous K-wire fixation of the humerus fracture with a single K-wire. Five days postoperatively the patient experienced increased pain and dyspnea due to a pneumothorax caused by intrathoracic migration of the K-wire. Percutaneous fixation can be a suitable treatment for low-maintenance and fragile patients but surgeons should act with caution. Multiple threaded K-wires with a bend-free end should be used to reduce the risk for loss of repositioning or migration of the K-wire.

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Acute versus delayed reverse total shoulder arthroplasty for the treatment of proximal humeral fractures in the elderly population: a systematic review and meta-analysis

Cited by 52 publications

References 42 publications

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review

Intrathoracic migration of a K-wire after percutaneous fixation of a proximal humerus fracture.

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