Abstract
Background
In elderly patients with complex proximal humerus fractures and osteoporotic bone reconstruction is not always possible. Although hemiarthroplasty is an alternative, non-union or tuberosity migration can lead to inferior functional results. Implantation of a Reverse Total Shoulder Arthroplasty (RTSA) seems to be an interesting alternative. In the present study we retrospectively analyzed the short-term results of RTSA for complex proximal humerus fractures in the elderly.
Methods
From 31.10.2005 to 20.07.2010 RTSA was performed in 29 patients (average age 80 years [67;90], 25 women, 4 man) with subcapital, three- or four-part fracture of the proximal humerus as a primary treatment. All procedures were performed using the Anatomical Inverse Shoulder (Zimmer) with fracture stem. A deltopectoral approach was used in every case with reattachment of the tuberosities. Pain, range of motion, subjected shoulder value (SSV) as well as the Constant score (CS) were used to evaluate shoulder function. Implant positioning and signs of loosening were analyzed on standard x-rays.
Results
Included were 23 patients with a minimal follow-up of 12 month. The average follow-up was 17 month (12 month to 5 years). The mean SSV was 81% [40;100]. The absolute CS averaged 67 points [34;84] and the relative CS 97% [52;139]. The mean pain score (VAS) was 13.7 of 15, the mean activity score 18.4 of 20, the mean mobility score 28.6 of 40 and the mean strength score 5.1 of 25. The mean active anterior elevation was 130° [80;160], the mean active abduction 128° [80;170] and the mean active external rotation in 0° abduction 21° [-30;70]. All patients reached the same activity level as before surgery and could return to independent living. The results after 12 month were already comparable to those after 24 month (10 patients). Radiographically no signs of loosening were detected. There was a total of 3 complications and reoperations, two due to a hematoma and one because of a periprosthetic fracture.
Conclusions
In elderly patients with complex proximal humerus fractures and osteoporotic bone RTSA seems to be a very satisfactory procedure. The short-term clinical results are excellent and predictable with a rapid postoperative recovery of daily comfort. The complication rate is low and acceptable.
