Reverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis.
BACKGROUND
Surgical treatment of proximal humeral fractures in the elderly pose challenges in decision making. Reverse total shoulder arthroplasty (RTSA) has been established as a reliable option for salvage of failed hemiarthroplasty, although few studies have analyzed RTSA after failed open reduction with internal fixation (ORIF). This study evaluated the outcomes of patients with failed osteosynthesis who undergo salvage RTSA compared with patients undergoing primary RTSA for proximal humeral fractures.


METHODS
We retrospectively reviewed 18 patients who underwent primary RTSA for acute proximal humeral fractures and 26 patients who underwent arthroplasty after failed ORIF at our institution between 2003 and 2013. Minimum follow-up was 2 years, with a mean follow-up 3 years (range, 2.0-6.0 years).


RESULTS
There are no statistically significant differences in clinical outcomes between the two cohorts in the American Shoulder and Elbow Surgeons scores and in the most recent forward flexion or external rotation. The salvage RTSA cohort experienced a higher complication rate (8%), including dislocation and aseptic loosening. The primary RTSA cohort had a 5% complication rate, with 1 late prosthetic joint infection requiring reoperation.


CONCLUSIONS
Although RTSA after failed ORIF has a higher rate of complications compared with acute RTSA, the revision and reoperation rate as well as clinical outcomes and shoulder function remained comparable. When a surgeon approaches these complex fractures in patients with poor underlying bone stock, this study supports acute arthroplasty or ORIF with the knowledge that salvage RTSA still has the potential to achieve good outcomes if osteosynthesis fails.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: Shannon.steven@mayo.edu.
Steven F
SF
Shannon
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Eric R
ER
Wagner
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Matthew T
MT
Houdek
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
William W
WW
Cross
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Joaquin
J
Sánchez-Sotelo
D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
Proximal humeral fracture; elderly patients; failed osteosynthesis; open reduction internal fixation; osteoporosis; reverse total shoulder arthroplasty