Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis

Abstract

Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies. We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach. Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively). RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049

Management of Proximal Humerus Fractures in Adults—A Scoping Review

“…When compared with hemiarthroplasty, RSA for treatment of proximal humeral fractures has been shown to have improved Constant scores, better active forward flexion, and better abduction [ 84 , 90 , 91 , 92 ].…”

“…There have also been a number of studies and meta-analyses directly comparing RSA to ORIF and HA. Suroto et al found that RSA had lower rates of revision surgery, better forward flexion and abduction, and superior functional outcome measured by Constant Scores when compared with ORIF [ 91 ]. Perhaps the highest quality most recent study, the DelPhi study, demonstrated Constant scores that were 13.4 points higher in the RSA group than the ORIF group [ 92 ]; however the editors cautioned that follow-up was limited to two years [ 96 ].…”

A Case of Proximal Humerus Fracture Dislocation Presenting With Failed Primary Open Reduction and Internal Fixation Followed by Salvage Reverse Total Shoulder Arthroplasty

“…The literature has demonstrated that ORIF compared to rTSA for displaced three-part or four-part PHF has lower complication rates and higher revision rates. ORIF and rTSA were shown to be comparable in their ranges of motion [ 14 ]. Shoulder arthroplasty should be avoided in younger populations to prevent the need for revision arthroplasty.…”

Perioperative management of closed fracture subtrochanteric femur sinistra in type 2 diabetes mellitus with multiple comorbid: A case report

“…The patient was prepared for fasting from midnight, omitting the morning dose of OAD and insulin, and received low-molecular-weight heparin (LMWH) of 40 mg/12 h from the second day of pre-surgical. Successful ORIF procedure in the operating room was obtained [8] , [9] . On the 4th day post-surgery, the fasting blood glucose patient of 140 mg/dL, and she continue to received insulin aspart of 6–6–6 U, detemir of 8 U, metformin of 500 mg/12 h, acarbose 50 mg/8 h, and pioglitazone 30 mg/24 h, telmisartan 80 mg/24 h and bisoprolol 5 mg/24 h. The patient is planned to follow up in the internal and surgeon devision outpatient ward.…”