title: Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults.
abstract: BACKGROUND
  The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups.
  
  
  METHODS
  A retrospective review was performed on all 3- and 4-part proximal humeral fractures treated with either RSA or nonoperative treatment with minimum 1-year follow-up. All patients in the nonoperative cohort were offered RSA but declined. Objective patient data were obtained from medical records. Patient-reported outcomes including visual analog scale score, Single Assessment Numeric Evaluation score, Penn Shoulder Score, American Shoulder and Elbow Surgeons score, resiliency score, and Veterans Rand-12 scores were obtained at follow-up. Statistical analysis was performed by use of the Student t test for continuous variables and χ2analysis for nonparametric data.
  
  
  RESULTS
  We analyzed 19 nonoperative and 20 RSA patients with a mean follow-up period greater than 2 years (29 months in nonoperative group and 53 months in RSA group). There were no differences in range of motion between groups (forward elevation, 120° vs 119° [P = .87]; external rotation, 23° vs 31° [P = .06]). No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes. Among patients receiving RSA, there was no difference in outcomes in those undergoing surgery less than 30 days after injury versus those receiving delayed RSA.
  
  
  CONCLUSIONS
  This study suggests that there are minimal benefits of RSA over nonoperative treatment for 3- and 4-part proximal humeral fractures in older adults.
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Troy A
authors.initials: TA
authors.lastname: Roberson
authors.affiliation: School of Medicine, University of South Carolina, Greenville, SC, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Granade
authors.affiliation: School of Medicine, University of South Carolina, Greenville, SC, USA.
authors.forename: Quinn
authors.initials: Q
authors.lastname: Hunt
authors.affiliation: School of Medicine, University of South Carolina, Greenville, SC, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Griscom
authors.affiliation: Hawkins Foundation, Greenville, SC, USA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Adams
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Momaya
authors.affiliation: Hawkins Foundation, Greenville, SC, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Kwapisz
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kissenberth
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Tolan
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hawkins
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA. Electronic address: Jtokish@ghs.org.
authors.forename: John M
authors.initials: JM
authors.lastname: Tokish
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D000072700:Conservative Treatment / Q000379:methods*; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000628:therapy*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Proximal humeral fracture; complications; nonoperative treatment; older adult; patient-reported outcomes; reverse shoulder arthroplasty