Early vs. late reverse shoulder arthroplasty for proximal humerus fractures: does it matter?

Seidl, Adam J.; Sholder, Daniel; Warrender, William J.; Livesey, Michael; Williams, Gerald R.; Abboud, Joseph A.; Namdari, Surena

doi:10.1016/j.jse.2016.12.003

Cited by 15 publications

(46 citation statements)

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“…Five studies were identified that satisfied all inclusion and exclusion criteria. 26,[40][41][42][43] Three studies were retrospective cohorts 26,42,43 while the other two were matched casecontrol. 40,41 All studies were published between 2016-2020.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…Two of the studies included failed hemiarthroplasty, ORIF, and non-operative treatment as part of the salvage group, 41,42 one included failed hemiarthroplasty, ORIF and intramedullary nailing, 43 and two studies only included patients who failed ORIF. 26,40 Common outcomes between the studies included forward flexion, 26,[40][41][42][43] external rotation, 26,[40][41][42][43] ASES, 26,41,42 UCLA score, 40,41 and Constant Score. 40,41,43 The characteristics of each study are summarized in Table 1.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

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Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

Nelson

Kwan

Tjong

et al. 2020

Journal of Shoulder and Elbow Arthroplasty

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Background There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure. Methods A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan. Results Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA. Conclusions Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.

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Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

Nelson

Kwan

Tjong

et al. 2020

Journal of Shoulder and Elbow Arthroplasty

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“…This was slightly contradictory to a previous paper which showed improved tuberosity healing and external rotation when a reverse is performed for an acute fracture. 67 The newer stemless implants have been advocated as a possible solution for the challenges of an arthroplasty in the face of a malunion; however, long-term follow-up is still required for this indication.…”

Section: Delayed Vs Early Reverse Total Shoulder Replacementmentioning

confidence: 99%

Proximal humerus fractures - Part 1: Conservative management

et al. 2019

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Fractures of the proximal humerus are common, especially in osteoporotic females. Despite this, there remains significant debate around their preferred treatment. The difficulties when considering treatment options is the wide array of fracture patterns and multiple patient factors which play an important role in the outcome of the management of these fractures. Fortunately, the vast majority of these fractures can be treated conservatively. The challenge, however, is the 15% of patients in which surgery may be required such as displaced three-and four-part fractures, and fractures in young and active patients. Although various recent studies and review papers show acceptable results with conservative treatment, especially in elderly patients, the decision on when to operate and when to consider conservative treatment remains challenging. The goal of this current concepts paper is to highlight important aspects of the conservative management of patients with proximal humerus fractures, from initial assessment through to treatment, including possible complications.

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“…1; [11,34,39]). Although HSA has fewer complications and grants better function than internal fixation systems, it remains associated with inconsistent outcomes, particularly in elderly patients, owing to proximal humeral migration as well as osteolysis, malunion, nonunion, or tuberosity resorption [15,33,34,39].…”

Section: Introductionmentioning

confidence: 99%

“…2) gained acceptance as an alternative treatment for complex PHF in elderly patients [11,15,39], because it relies on the deltoid muscle to restore shoulder function and hence circumvents poor tuberosity healing or concomitant rotator cuff tears [24,34]. Despite encouraging results, many surgeons hesitate to treat acute PHF by RSA, because it is more invasive and could lead to potentially more complications in the long term [4,7,11,15,33,34,39].…”

Section: Introductionmentioning

confidence: 99%