Results showed reverse shoulder arthroplasty yielded better outcomes and fewer complications among patients who developed proximal humeral fracture sequelae after conservative treatment compared with open reduction and internal fixation.
Researchers recorded functional outcomes in 27 patients who underwent reverse shoulder arthroplasty (RSA) for treatment of proximal humeral fracture sequelae following either conservative treatment or open reduction and internal fixation (ORIF) from September 2006 to December 2013. Researchers also collected plain X-rays and a CT scan prior to surgery and plain X-rays after surgery and recorded all complications and reoperations during follow-up.
Although both groups experienced significantly increased Constant scores after surgery, results showed patients in the conservative group had significantly better outcomes for the total Constant score, forward elevation and external rotation. Researchers found patients in the conservative group had a mean postoperative forward elevation of 95° compared with 77° among patients in the ORIF group. Patients in the conservative treatment and ORIF groups also had a mean postoperative abduction of 74° and 68°, respectively. During the follow-up period, researchers noted an overall complication rate of 14.8%, with one infection in the conservative group and two dislocations and one infection in the ORIF group.
“Conservative treatment of acute proximal humeral fractures should be more frequently considered because, despite [that] RSA offers limited outcomes in patients with [proximal humeral fracture sequelae] PHFS, the complications of RSA after failed conservative treatments are low,” the authors wrote. “Therefore, indication for ORIF in acute proximal humeral fracture should be limited to those cases where a good outcome is likely, being especially cautious when indicating ORIF in elderly individuals.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.