Reverse Shoulder Arthroplasty for the Management of Proximal Humerus Fractures

Abstract

The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three- and four-part proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Inferior results with plate osteosynthesis are often a result of complications of humeral head osteonecrosis, loss of fixation, and screw penetration through the humeral head, whereas major concerns with hemiarthroplasty are tuberosity resorption, malunion, and nonunion resulting in pseudoparalysis. Comparative studies support the use of reverse shoulder arthroplasty in elderly patients with complex proximal humerus fractures because the functional outcomes and relief of pain are reliably improved. Repair and union of the greater tuberosity fragment during reverse shoulder arthroplasty demonstrates improved external rotation, clinical outcomes, and patient satisfaction compared with outcomes after tuberosity resection, nonunion, or resorption. Satisfactory results can be obtained with careful preoperative planning and attention to technical details.

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

“…Nonunion, malunion, and resorption or migration of the greater tuberosity are the most common complications and ultimately lead to inconsistent and mainly disappointing functional results. 1,3,5,12,16,23,28 Therefore, a current trend from hemiarthroplasty toward RTSA is reported for complex humeral fractures in the elderly. 38 RTSA yields better functional outcomes and a lower complication rate than hemiarthroplasty in the treatment of complex fractures of the proximal humerus in the elderly.…”

Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population

“…10 However, displaced and unstable fractures can be treated with open reduction and internal fixation (ORIF), hemiarthroplasty, total shoulder arthroplasty (TSA), or reverse total shoulder arthroplasty (RTSA). 13,27 The patient's age and functional activity level and the surgeon's preference, training, and ability to reconstruct the fragments all play a critical role in determining the best primary treatment for patients with this type of injury. 13,27 A recent Cochrane review of treatments for PHF found that there is insufficient evidence to support the best treatment option, 11 and the indications for each continue to evolve.…”

Komplexe proximale Humerusfrakturen

“…Dislozierte undinstabileFrakturenwerdenhäufigos-teosynthetisch (winkelstabile Plattenosteosynthese, proximaler Humerusnagel) oder in Abhängigkeit von der Rekonstruierbarkeit der Gelenkfläche und der Knochenqualität endoprothetisch versorgt [6,7] …”

“…Dislozierte undinstabileFrakturenwerdenhäufigos-teosynthetisch (winkelstabile Plattenosteosynthese, proximaler Humerusnagel) oder in Abhängigkeit von der Rekonstruierbarkeit der Gelenkfläche und der Knochenqualität endoprothetisch versorgt [6,7]. Das Patientenalter und der Aktivitätsgrad des Patienten sind neben dem Erfahrungsgrad des Chirurgen, Repositionsmöglichkeit der Fraktur und operativer Präferenz Entscheidungsfaktoren der operativen Vorgehensweise.…”

“…Nach aktueller Studienlage ist eine primäre endoprothetische Frakturversorgung bei komplexen 3-und 4-Part-Humeruskopffrakturen mit Head-split-Komponente, fortgeschrittener Osteoporose oder gescheiterter Osteosynthese indiziert. Die betroffenen Patienten mit einem gescheiterten Osteosyntheseverfahren werden im weiteren Verlauf zunehmend auf ein prothetisches Verfahren konvertiert [6,11].…”