title: Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations.
abstract: BACKGROUND
  The treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function.
  
  
  OBJECTIVE
  We (1) evaluated ROM, pain level, and American Shoulder and Elbow Surgeons scores of patients who had a reverse total shoulder arthroplasty for displaced three- and four-part proximal humerus fracture and (2) identified clinical and radiographic complications from the procedure.
  
  
  METHODS
  We retrospectively reviewed 30 patients in three institutions who had undergone a primary reverse total shoulder arthroplasty for displaced three- or four-part proximal humerus fractures. Mean age was 77 years (range, 65-94 years). Minimum followup was 12 months (mean, 23 months; range, 12-36 months).
  
  
  RESULTS
  Mean postoperative American Shoulder and Elbow Surgeons score was 78 (range, 36-98), mean active forward flexion was 139° (range, 90°-180°), and mean active external rotation was 27° (range, 0°-45°). Mean American Shoulder and Elbow Surgeons pain score was 0.7 (range, 0-5) and mean visual analog scale pain score was 1.1 (range, 0-5). Complications were identified in three of 30 patients (10%).
  
  
  CONCLUSIONS
  At short term, reverse total shoulder arthroplasty relieved pain and improved function. The complication rate compared favorably with those reported for other treatment alternatives.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors: The Case Shoulder & Elbow Service, Department of Orthopaedic Surgery, University Hospitals of Cleveland, 11100 Euclid Avenue, HH5043, Cleveland, OH 44106, USA.
authors: Christopher
authors: C
authors: Lenarz
authors: Yousef
authors: Y
authors: Shishani
authors: Christopher
authors: C
authors: McCrum
authors: Robert J
authors: RJ
authors: Nowinski
authors: T Bradley
authors: TB
authors: Edwards
authors: Reuben
authors: R
authors: Gobezie
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D018460:Fractures, Comminuted / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000503:physiopathology / Q000601:surgery*