title: Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly.
abstract: BACKGROUND
  Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population.
  
  
  METHODS
  Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months).
  
  
  RESULTS
  There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity.
  
  
  CONCLUSIONS
  The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome.
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Grubhofer
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Wieser
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Dominik C
authors.initials: DC
authors.lastname: Meyer
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Catanzaro
authors.affiliation: Department of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
authors.forename: Silvan
authors.initials: S
authors.lastname: Beeler
authors.affiliation: Department of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Riede
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: christian.gerber@balgrist.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complex proximal humeral fracture; elderly patients; greater tuberosity displacement; greater tuberosity healing; greater tuberosity resection; reverse total shoulder arthroplasty