Reverse Total Shoulder Replacement for Acute Complex Proximal Humeral Fractures in Patients Over 70 Years Old: Early Return to Pain Free Activities

Good outcome reported with reverse total shoulder replacement (rTSA) for cuff arthropathy.

Aim: To assess clinical and radiological results with rTSA for acute proximal humerus fractures.

Materials and Methods: Between 2007 and 2014, seventeen patients (1 bilateral), with acute complex proximal humerus fractures were treated using stemmed rTSA. Mean age 81.5 years (71 – 91y). 15 females and 2 males for head split (5), fracture dislocations (3), four-part fractures (9) and displaced 2 part fracture (1). Patients were assessed clinically with Constant score (CS), Pain score, patient satisfaction and Subjective shoulder value (SSV) and return to function as well as radiologic assessment.

Antero-superior approach was used. The tuberosities were reattached to the humeral shaft and around the proximal stem with suture fixation.

Postoperatively the arm was immobilized in a sling for 3 weeks and following X-rays review, mobilisation and rehabilitation was initiated. All patients were ready to be discharged within 2 days from surgery.

Results: Pain improved early with 9.5/15 pain score at 3 months to 12/15 at six months and painfree at final follow up with high satisfaction.

Constant score 72 (range 38-82) and ADLEIR scores (Activities of Daily Living External and Internal Rotation score) 35/36 (range 32 - 36) respectively. All patients resumed their normal ADLs as early as 3 months post surgery.

Elevation improved to 155º (range 90º - 180º), Abduction to 135º (range 70º - 180º), External rotation 42.5º, and internal rotation 85º.

Radiographically, the tuberosities healed at 6 months in all the cases. No lucencies, subsidence, stress shielding, or loosening observed. 1 inferior glenoid traction osteophyte and one glenoid notching (grade 2).

Conclusion: The stemmed rTSA with reattachment of the tuberosities seem to be safe and successful for the treatment of complex proximal humeral fractures in patients over 70 years old with early return to pain-free function as early as three months.