Elderly patients with head-split fractures may have better outcomes with reverse total shoulder arthroplasty compared with open reduction and internal fixation or hemiarthroplasty, according to published results.
Paulina-Marie Peters, of the Center for Musculoskeletal Surgery at Charité – Universitaetsmedizin Berlin in Berlin, Germany, and colleagues assessed subjective shoulder value, simple shoulder test, Constant Score and biplanar radiographs in 30 patients with head-split fractures undergoing open reduction and internal fixation (ORIF; n=24), reverse total shoulder arthroplasty (TSA; n=4) or hemiarthroplasty (n=2). Researchers analyzed fracture pattern, quality of reduction, eventual complications, revision procedures and clinical failure, and calculated risk factors for failure.
Results showed an overall complication rate of 83%, with humeral head osteonecrosis, malunion of the lesser tuberosity and screw protrusion as the most common complications following ORIF and all complications following reverse TSA related to tuberosity problems. Researchers found 29% of patients in the ORIF group underwent revision compared with no patients in the reverse TSA and hemiarthroplasty groups. Among patients who in the ORIF group, 17% underwent conversion to reverse TSA and 12.5% had screw removal due to penetration, according to results.
Researchers noted a 50% overall clinical failure rate, with no significant association between preoperative factors and clinical failure. Results showed higher average clinical outcome scores in the ORIF and primary reverse TSA groups vs. the primary hemiarthroplasty and secondary reverse TSA groups. Worse subjective shoulder values, simple shoulder test and adjusted Constant scores were found among patients who required revision, according to results.
“Head-split fractures of the proximal humerus remain a treatment challenge with high complication rates and unsatisfying clinical outcome in several cases after ORIF,” Peters told Healio Orthopedics. “Even though ORIF remains the preferred treatment option in younger patients for head-split fractures, it needs to critically be considered in elderly patients.” – by Casey Tingle
Disclosures: Peters reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.