Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty

B Israel Yahuaca; Peter Simon; Kaitlyn N Christmas; Shaan Patel; R Allen Gorman 2nd; Mark A Mighell; Mark A Frankle

doi:10.1016/j.jse.2019.10.012

Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty

J Shoulder Elbow Surg. 2020 Jul;29(7S):S32-S40. doi: 10.1016/j.jse.2019.10.012. Epub 2020 Jan 13.

Authors

B Israel Yahuaca¹, Peter Simon², Kaitlyn N Christmas², Shaan Patel³, R Allen Gorman 2nd², Mark A Mighell¹, Mark A Frankle⁴

Affiliations

¹ Shoulder & Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA.
² Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
³ Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
⁴ Shoulder & Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.

PMID: 31948835
DOI: 10.1016/j.jse.2019.10.012

Abstract

Background: Proximal humerus fracture treatment varies by surgeon preference and patient factors. This study compares patient and fracture characteristics, with outcomes between current surgical treatment options.

Methods: Between 1999 and 2018, 425 proximal humerus fractures underwent acute surgical management: open reduction internal fixation (ORIF, n = 211), hemiarthroplasty (HA, n = 108), or reverse shoulder arthroplasty (RSA, n = 106). Patient and fracture characteristics included age, American Society of Anesthesiologists physical status classification (ASA), and fracture classification. Postoperative motion at 3, 6, and minimum 12 months (avg 20 ± 21 months), radiographic outcomes, and postoperative falls were analyzed.

Results: Average age for treatment groups was 65 ± 13 years (range: 18-93 years). Fractures were classified as 2- (11%), 3- (41%), or 4-part (48%). Age, ASA, and fracture classification were associated with selected surgical management (P < .0001, =.001, <.0001, respectively). Outcomes showed a significant improvement in forward flexion from 3 months to 6 months in all groups (P < .0001). No difference in final motion was seen between groups. Radiographic union was higher in ORIF (89%), and similar between HA (79%) and RSA (77%, P = .005). Rate of reoperation was RSA 6.6%, ORIF 17.5%, and hemiarthroplasty 15.7% (P = .029). Postoperatively, 23% patients had at least 1 fall, of which 73% resulted in fractures.

Conclusion: Older patients with high ASA were treated with arthroplasty, and younger patients with lower ASA were treated with ORIF. All groups showed improvements in motion. At minimum 1 year of follow-up, there was no difference in motion between groups. ORIF and HA showed significantly more reoperations compared with RSA. Patients should be counseled about reoperation, fall risk, and prevention.

Keywords: ORIF; Proximal humerus fracture; fragility fracture; hemiarthroplasty; proximal humeral fracture; reverse shoulder arthroplasty.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Arthroplasty, Replacement, Shoulder* / methods
Female
Fracture Fixation, Internal*
Fracture Healing
Hemiarthroplasty*
Humans
Male
Middle Aged
Open Fracture Reduction*
Postoperative Period
Range of Motion, Articular
Reoperation
Shoulder Fractures / classification
Shoulder Fractures / diagnostic imaging
Shoulder Fractures / physiopathology
Shoulder Fractures / surgery*
Shoulder Joint / diagnostic imaging
Shoulder Joint / physiopathology
Shoulder Joint / surgery*
Treatment Outcome
Young Adult