Open reduction internal fixation vs. reverse shoulder arthroplasty for the treatment of acute displaced proximal humerus fractures

Factors influencing surgical management of proximal humerus fractures: do shoulder and trauma surgeons differ?

“…We found that surgeons are increasingly treating PHFs in the elderly with RSA instead of HA or ORIF, which is generally corroborated by recent literature. 18,24 We also identified differences based on fellowship training; shoulder surgeons more commonly recommended arthroplasty in tuberosity comminution and significant metaphyseal comminution, whereas trauma surgeons preferred ORIF or nonoperative management.…”

“…In 2015, a Cochrane Review of 31 PHF randomized controlled trials concluded that there was insufficient evidence to inform choices between different surgical interventions. 20 Despite this, many clinical studies in elderly patients with PHFs have reported superior outcomes in favor of RSA 3,6,8,15,18,24,41 over ORIF, 31 HA, 32 and equivalent outcomes for nonoperative management. 11,25,27,37 Systematic reviews analyzing PHFs in the elderly population have found superior outcomes for ORIF 19,35 and similar or more favorable outcomes for RSA compared with HA.…”

The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population

“…The advent of locking plates has made the treatment of osteoporotic PHFs more amenable to surgical intervention and has reported improved functional outcomes [ 27 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. However, maintaining an anatomic reduction and avoiding osteonecrosis, screw penetration, malunion and nonunion continues to be a challenge with the use of locking plates [ 43 ].…”

“…Multiples retrospective studies have compared RTSA to ORIF in the treatment of PHF ( Table 2 ), the outcomes vary amongst these different studies [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. When assessing patient reported outcomes, no significant differences were seen between RTSA and ORIF but RTSA demonstrated better ranges of motion, especially in forward flexion [ 35 , 36 , 37 ]. Additionally, these studies show a trend towards more complications and more revision surgeries in the ORIF group [ 37 , 38 , 39 , 40 , 42 ].…”

“…When assessing patient reported outcomes, no significant differences were seen between RTSA and ORIF but RTSA demonstrated better ranges of motion, especially in forward flexion [ 35 , 36 , 37 ]. Additionally, these studies show a trend towards more complications and more revision surgeries in the ORIF group [ 37 , 38 , 39 , 40 , 42 ]. However, 3- or 4-part fracture dislocations and head split fractures which are typically treated with arthroplasty were excluded from most of these studies.…”