Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes?

Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities?

“…The unreliable results achieved with HA in elderly patients have prompted attempts at treating these patients with the RSA. [8][9][10][11]13,17,20,[22][23][24]27,[29][30][31][32][33][34] The need and potential benefits of tuberosity fixation and healing around such implants remain controversial, and low rates of tuberosity healing (as low as 40%) 8,13,17,20,32 have been reported in some published series of RSA for fractures in the elderly population. Moreover, because the RSA can overcome cuff deficiency, 2 some authors have recommended not reattaching or even excising the tuberosities in RSA for displaced PHFs.…”

“…8,21,[23][24][25]27,29,33,35 Some authors have recommended not reattaching or even excising the tuberosities when treating PHFs with a RSA 11,12,16,21 ; however, severe complications, such as instability, infection, and implant loosening, have been reported when the tuberosities do not heal around the reverse stem. 9,16,21,23,24,[27][28][29]34,35 Although recent studies have shown that tuberosity healing in the elderly is associated with better range of motion and function, 13,17,20,32 the rates of tuberosity healing vary from 40% to 84% in this elderly population. Thus, a question still remains and needs to be answered: is it worth reattaching the tuberosities in RSA for acute fractures in the elderly?…”

How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures

“…RSA for the treatment of displaced PHFs in elderly patients is gaining popularity among surgeons because clinical results are more reliable than those obtained with hemiarthroplasty. 1,[4][5][6][7]11,13,15 Since RSA has been designed to overcome cuff-deficient shoulders, some surgeons have proposed excising the tuberosities, 5,6 whereas others have suggested that tuberosity reattachment is less important than in hemiarthroplasty. 10,11 The question that we attempted to answer in this study was as follows: Are clinical and subjective outcomes of RSA for PHFs comparable in the case of tuberosity excision, failed fixation, or anatomic healing?…”

Reverse total shoulder arthroplasty

“… 36 However, the results of both HA and ORIF are unpredictable because of dependence on anatomical tuberosity healing. 32 , 37 , 38 The complication and failure rates of ORIF to treat shoulder fractures can be high. 39 RTSA may be a more reliable treatment for complex proximal humerus fractures because its functional outcomes appear to depend less on tuberosity healing and rotator cuff integrity ( Fig.…”

“… 40 , 41 However, some authors have suggested that tuberosity repair is associated with increased external rotation compared with no repair. 38 , 40 RTSA can also be a valuable salvage procedure after failed ORIF of a proximal humerus fracture, with a relatively low revision rate. 42 , 43 …”