Abstract
Whilst the use of reverse total shoulder arthroplasty is becoming more common for the treatment of rotator cuff arthropathy, there is still relatively little evidence with regards to its use in complex fractures of the proximal humerus in the elderly. It is increasingly felt to be of use in those patients in whom either internal fixation is not possible due to fracture configuration or bone quality, or in whom there is a rotator cuff deficiency.
We report the outcomes of 14 patients with complex 3- or 4-part humeral fractures or delayed presentation of dislocation treated with reverse TSR. Patients were treated within a two year period from January 2011 to December 2013. The average age at time of operation was 75 (50–91 years) with a mean follow-up of 7 months (2–13 months). One patient moved out of area and one lost to follow-up two months following procedure.
Reverse TSR was considered a salvage procedure for patients with comminuted proximal humeral fractures or those who presented with irreducible non-acute dislocations. At time of last follow-up all 14 patients were satisfied with the results of their operation and functionally independent with activities of daily living. Range of movement post-operatively was good with mean active forward extension 97° (70–150°) and abduction 101° (80–170°). 43% of patients were pain-free, whilst the remainder only required the use of occasional analgesia. No major post-operative complications were reported.
Patients who underwent reverse TSR for dislocation fared better than for those with proximal humeral fractures. The mean active forward extension was 107.5° (90–150°) and abduction 112.5° (90–170°) in the dislocation group (n=5) compared with those who had a fracture in which the forward extension was 91.4° (70–120°) and abduction 95° (80–120°).
The results of these patients demonstrate that reverse TSR should be considered in patients with complex proximal humeral fractures or delayed presentation of fractures. It seems to provide consistently excellent pain-relief for patients, with patients either reporting being pain-free or requiring only occasional analgesia. In addition, all patients treated were functionally independent following operation. Range of movement, particularly for those with dislocation, appear good. Further follow-up is required to ensure sustained results but early studies are encouraging.
