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

Introduction

Complex proximal humeral fractures in the elderly population are difficult to treat due to osteoporotic bone, risk of humeral head necrosis and compromised rotator cuff. In the last decade, reverse shoulder arthroplasty (RSA) is gaining popularity in the treatment of these patients. The goal of this study was to evaluate radiological at mid term clinical outcome of elderly patients with acute, complex fractures of the humerus that underwent reverse shoulder arthroplasty in our institute.

Materials and Methods:

Twenty-four patients were treated with RSA for an acute, complex fracture of the proximal humerus in our institute between April 2012 and June 2015. 22 of the 24 patients were available for follow up at a minimum of 12 month after surgery. There were 16 female and 6 male patients, the mean age was 74.9 years (range 64-94). Clinical and radiological outcomes were evaluated at a mean follow-up of 27 months after surgery.

Results:

There was a significant increase in active forward flexion, external rotation, and internal rotation in all patients. Average active forward flexion at the final follow up was 145.7°, external rotation 35.6°, and internal rotation 40.1°. Pain significantly improved to 13/15 and patient satisfaction was 8.6/10. Tuberosity healing was observed in 87% of the cases. Range of motion was higher among patients who demonstrated radiographic evidence of tuberosity healing. 4 inferior glenoid traction osteophyte and one of glenoid notching - grade II were seen. No lucencies, subsidence, stress shielding or implant loosening were evident on the x-rays.

Conclusion

Reverse shoulder arthroplasty is a viable solution to treat complex humerus proximal fracture in the elderly population. The short-midterm clinical results are predictably good, with low complication rate and marked improvement in range of motion, pain and patient satisfaction.