Timing of Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures in Elderly Patients does not Affect Clinical Outcomes and Complication Rate

Introduction: Previous studies suggest that delaying surgery for complex proximal-humerus-fractures may be associated with increased patient morbidity and inferior long-term clinical outcome. Nevertheless, the available data regarding the effect of surgical timing in elderly patients undergoing reverse shoulder arthroplasty (RSA) for acute proximal-humerus-fractures is still limited and no formal guidelines exist. This study evaluates the influence of surgical timing on clinical outcome and complication rate in this group of patients.

Methods: Fifty-seven patients aged 75±6 years (range 63-88 years) with acute comminuted proximal-humerus-fractures underwent RSA in our institution from 2013 to 2017. All procedures were performed by one of two shoulder consultants using the same prosthesis and surgical technique, at an average delay of 9±6 days from injury (range, 2-32 days) related to non-medical reasons. Patients whose surgery was delayed for medical causes were not included in the study. Clinical and radiographic outcomes at 3-month and at least 1-year follow-up (mean follow-up of 33±18 months, range 13-66 months) were retrospectively reviewed and compared between patient who were operated on within 3 days from injury (n=10), 4 to 7 days from injury (n=21) and 8 to 32 days from injury (n=26).

Results: The average pain score for the entire cohort at 3-month and at the latest follow-up was 4.0±1 and 2.3±1 respectively. The average active forward flexion at 3-month and at the latest follow-up was 92±31 and 115±29 degrees respectively. Active external rotation averaged 4±16 and 15±17 degrees at 3-month and at the latest follow-up respectively. Two patients developed early prosthetic infection requiring prosthesis removal. Statistical analysis showed no significant differences between the three surgical timing groups in terms of clinical outcome and complication rate.

Conclusion: Our findings indicate that delaying surgery in elderly patients undergoing RSA for acute proximal-humerus-fracture does not affect clinical outcomes and complication rate at 3-month and at almost 3-years follow-up.