Surgical Management of Proximal Humeral Fractures: The Emerging Role of Reverse Total Shoulder Arthroplasty

Abstract

Acute proximal humeral fractures are common injuries in elderly patients. These fractures can lead to significant pain and functional loss. Nonoperative treatment offers high rates of satisfactory function and pain relief in the majority of fractures, particularly in elderly patients. Open reduction and internal fixation, closed reduction and percutaneous pinning, and hemiarthroplasty are used for treating displaced proximal humeral fractures, depending on patient and fracture characteristics. Recently, reverse total shoulder arthroplasty has gained popularity for treatment of complex proximal humeral fractures due to a rapid recovery of active elevation and activities of daily living function. Although complications remain a concern, early results of reverse total shoulder arthroplasty for proximal humeral fractures have been promising. Future comparative outcome studies are needed to define the indications for reverse total shoulder arthroplasty instead of nonoperative and other operative options. Optimal treatment of proximal humeral fractures requires clinical judgment based on fracture characteristics, bone quality, patient factors, and surgeon experience with the array of available techniques. [Orthopedics. 2016; 39(3):e465-e473.].

Decreased Reoperations and Improved Outcomes With Reverse Total Shoulder Arthroplasty in Comparison to Hemiarthroplasty for Geriatric Proximal Humerus Fractures: A Systematic Review and Meta-Analysis

“…More recently, reverse total shoulder arthroplasty (RSA) has been introduced as an alternative treatment option, [11][12][13][14][15][16] and its use has increased dramatically within the United States. [17][18][19] Purported benefits of RSA compared with HA include less dependence on tuberosity healing for improved active overhead function, decreased pain, and lower incidence of revision surgery.…”

Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty

“…The indications for RTSA have been increasing, [19][20][21][22][23][24] but the post-surgical rehabilitation of cuff-deficient shoulders remains more challenging than those with a functioning rotator cuff. 25 Therefore, further review of history, complications and muscle function will add to the body of knowledge in this area.…”

Physical therapy prehabilitation on a reverse total shoulder replacement candidate: a case study

“…The use of total shoulder replacement (TSR) has doubled in the last decade with up to 70,000 surgeries performed annually in the United States of which one-third are reverse TSR (rTSR) [15][16][17] . The reversed articular surfaces allows the deltoid muscle to become a primary elevator of the shoulder, thus, making it suited for individuals with advanced osteoarthritis (OA) and massive rotator cuff tears 18) .…”