Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly

TLDR

Long‑term outcomes are needed before reverse shoulder arthroplasty can be routinely recommended for complex proximal humerus fractures in the elderly. The study performed reverse shoulder arthroplasty on 43 elderly patients with three‑ or four‑part proximal humerus fractures and followed them for an average of 22 months. At follow‑up, patients achieved satisfactory shoulder function (mean active elevation 97°, external rotation 30°, Constant score 44, modified Constant 66 %) with common complications such as reflex sympathetic dystrophy, neurological issues, and one dislocation, while radiographs showed high rates of peri‑prosthetic calcification, tuberosity displacement, and scapular notching, yet mobility remained satisfactory compared to conventional hemiarthroplasty.

Abstract

We used an inverted shoulder arthroplasty in 43 consecutive patients with a mean age of 78 years (65 to 97) who had sustained a three- or four-part fracture of the upper humerus. All except two were reviewed with a mean follow-up of 22 months (6 to 58). The clinical outcome was satisfactory with a mean active anterior elevation of 97° (35° to 160°) and a mean active external rotation in abduction of 30° (0° to 80°). The mean Constant and the mean modified Constant scores were respectively 44 (16 to 69) and 66% (25% to 97%). Complications included three patients with reflex sympathetic dystrophy, five with neurological complications, most of which resolved, and one with an anterior dislocation. Radiography showed peri-prosthetic calcification in 36 patients (90%), displacement of the tuberosities in 19 (53%) and a scapular notch in ten (25%). Compared with conventional hemiarthroplasty, satisfactory mobility was obtained despite frequent migration of the tuberosities. However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly.