Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: Results and complications

Abstract

Introduction: The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable.

Objective: To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty.

Material and methods: A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3).

Results: Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%.

Conclusions: We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm.

Keywords: Alargamiento del brazo; Arm enlargement; Consolidación de tuberosidades; Fractura del húmero proximal; Notching; Proximal humerus fracture; Prótesis inversa de hombro; Reverse shoulder arthroplasty; Tuberosities consolidation.