P Luciani1, R Procaccini2, M Rotini2, F Pettinari2, A Gigante2. 1. Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy. pierfrancesco89@alice.it. 2. Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy.
Abstract
BACKGROUND: Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly. METHODS: We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up. RESULTS: Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%. CONCLUSION: In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient's quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.
BACKGROUND: Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly. METHODS: We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up. RESULTS: Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%. CONCLUSION: In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient's quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.
Authors: Daniel C Acevedo; Corinne Vanbeek; Mark D Lazarus; Gerald R Williams; Joseph A Abboud Journal: J Shoulder Elbow Surg Date: 2014-02 Impact factor: 3.019
Authors: Charles M Jobin; Gabriel D Brown; Maher J Bahu; Thomas R Gardner; Louis U Bigliani; William N Levine; Christopher S Ahmad Journal: J Shoulder Elbow Surg Date: 2011-11-06 Impact factor: 3.019
Authors: Peter N Chalmers; William Slikker; Nathan A Mall; Anil K Gupta; Zain Rahman; Daniel Enriquez; Gregory P Nicholson Journal: J Shoulder Elbow Surg Date: 2013-09-27 Impact factor: 3.019
Authors: H A Fink; K E Ensrud; D B Nelson; R P Kerani; P J Schreiner; Y Zhao; S R Cummings; M C Nevitt Journal: Osteoporos Int Date: 2003-01 Impact factor: 4.507
Authors: Sandra Boesmueller; Margit Wech; Markus Gregori; Florian Domaszewski; Adam Bukaty; Christian Fialka; Christian Albrecht Journal: Injury Date: 2015-10-22 Impact factor: 2.586
Authors: Antonio Giardella; Francesco Ascione; Mattia Mocchi; Marco Berlusconi; Alfonso Maria Romano; Francesco Oliva; Leonardo Maradei Journal: Muscles Ligaments Tendons J Date: 2017-09-18
Authors: Lorenzo Massimo Oldrini; Pietro Feltri; Jacopo Albanese; Francesco Marbach; Giuseppe Filardo; Christian Candrian Journal: Life (Basel) Date: 2022-02-19
Authors: Nadine Ott; Carolin Müller; Andreas Jacobs; Christian Paul; Kilian Wegmann; Lars Peter Müller; Koroush Kabir Journal: OTA Int Date: 2022-04-18