Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes?
BACKGROUND
The purpose of this study was to investigate whether healed tuberosities yield better rotational range of motion (ROM) and functional outcomes compared with unhealed tuberosities after reverse shoulder arthroplasty in elderly patients with comminuted proximal humerus fractures.


METHODS
This study included 38 patients who underwent reverse arthroplasty because of 4-part proximal humerus fractures; 14 patients had healed tuberosities (group A) and 24 patients had unhealed tuberosities (group B). Functional assessments included visual analog scale pain score, American Shoulder and Elbow Surgeons score, Constant score, and active ROM.


RESULTS
There were no significant differences in the patients' demographics between the 2 groups. At final follow-up, no significant differences were found between groups in visual analog scale score (group A, 1.4; group B, 1.6; P = .647), American Shoulder and Elbow Surgeons score (74.3 and 70.7; P = .231), and Constant score (67.9 and 63.9; P = .228) and ROM with forward flexion and internal rotation. However, in external rotation, there was a significant difference between groups (29° and 10° in external rotation with the elbow at the side [P < .001]; 25° and 7° in external rotation with shoulder abduction [P < .001]).


CONCLUSIONS
After reverse shoulder arthroplasty for 4-part proximal humerus fracture, tuberosities were healed in an anatomic position in 37% of patients. However, there were no significant differences in functional outcomes and ROM between the 2 groups, with the exception of external rotation, which was better in the healed tuberosity group. Therefore, tuberosity healing is not a prerequisite for satisfactory outcomes after reverse shoulder arthroplasty for 4-part proximal humerus fractures in elderly patients.
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Yong-Min
YM
Chun
Department of Orthopaedic Surgery, Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Republic of Korea.
Doo-Sup
DS
Kim
Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea.
Doo-Hyung
DH
Lee
Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea. Electronic address: sjshin622@ewha.ac.kr.
Sang-Jin
SJ
Shin
D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D064232:Visual Analog Scale
Proximal humerus; arthroplasty; fracture; repair; shoulder; tuberosity