Treatment of Complex Proximal Humeral Fractures in the Elderly with Reverse Shoulder Arthroplasty

Abstract

Objective: To assess the short-term efficacy of reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.

Methods: Forty-three elderly patients treated operatively for complex proximal humeral fractures with reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively reviewed. To be specific, 12 males and 31 females were reviewed with an average age of 72.0 years (range, 66-78 years). All fractures were attributed to trauma and treated for 8.0 days on average (range, 6-11 days). As suggested from Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, and 22 (51.2%, 22/43) were four-part fractures. To assess the postoperative efficacy, Visual Analog Scale (VAS), American Society of Shoulder and Elbow Surgery Shoulder Joint Score (ASES), Constant-Murley score and radiological examination were adopted. The Neer three-part fracture group and the Neer four-part fracture group were compared.

Results: There was no significant difference in age, gender, operation time, and follow-up period between Neer three-part fracture group and Neer four-part fracture group. All operations were successfully performed, and the average operation time was 120-170 min, with an average of 141.3 min. Besides, the mean blood loss was 407.0 mL (250-700 mL), and the average intraoperative blood transfusion reached 446.5 mL (400-800 mL). All patients received the follow-up for 6 to 16 months, that is for 10.9 months on average. All patients were discharged in 7 days after operation, and no wound-related complications were identified. In 8 weeks, the greater and lesser tuberosities of all patients healed completely. During the last follow-up, no loosening or dislocation of prosthesis was detected, and the forward elevation of 133.0 (100°- 165°), the external rotation of 29.5° (20°-35°), the internal rotation of 46.7°(30°-60°), the VAS score of 0.8(0-3), the ASES score of 89.1(78.8-100.0) were achieved. Constant-Murley score reached 88.7 (range, 70-98). There was no significant difference between Neer three-part fracture group and Neer four-part fracture group (P > 0.05). A 71-year-old patient developed the symptoms of axillary nerve injury after operation; he recovered completely at 6 weeks after the operation, which had not adversely affected the functional rehabilitation exercise or the stability of the prosthesis. At the follow-up, no other complications (e.g., infection, acromial stress fracture, and scapular notching) were identified in all patients.

Conclusion: The short-term efficacy of one-stage reverse shoulder arthroplasty to treat complex proximal humeral fractures in the elderly is satisfactory.

Keywords: Arthroplasty, replacement; Elderly; Shoulder fractures.