Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

Abstract

Background:Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.Methods:We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.Results:Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.Conclusion:Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

Factors influencing surgical management of proximal humerus fractures: do shoulder and trauma surgeons differ?

“…Challenges involving treating PHFs with RSA compared with nonoperative management include potential complications and a significant learning curve. 16 Alternatively, trauma surgeons may choose nonoperative management over RSA at a greater rate compared with shoulder surgeons based on a differing interpretation of the literature showing satisfactory outcomes in nonoperative management. For all scenarios involving elderly patients with PHFs, a greater proportion of trauma surgeons cited that they ''refer these patients'' compared with shoulder surgeons (fracture dislocation, head-split fracture, limited humeral head subchondral bone, and low functioning geriatric patient with a significantly displaced fracture [P < .001 in all scenarios]).…”

Engineering of Viscosupplement Biomaterials for Treatment of Osteoarthritis: A Comprehensive Review

“…This demands an effort to develop more innovative products solo or combined, as described in Table 1 in the preclinical status. [80][81][82][83][84][85][86][87][88][89][90][91][92][93][94] In the past 5 years, many products have been described in the literature (Table 1). Still, as seen later (Table 2), few have reached the preclinical and clinical stages, possibly verifying the total dominance of HA formulations.…”

“…Clinically, recent evidence suggested that the viscosupplements based in HA, CS, and PRP significantly improve pain and natural physical functions. [67,83] However, in addition to preclinical status, comparative studies and their efficacy are pretty limited, unclear, and controversial. Furthermore, some dissimilar studies include the severity of OA disease, joint locations (e.g., knee, ankle, shoulders), number of injections needed, treatment time, and the molecular weight of the products, among others.…”

Micromachined Tactile Sensor Array for RTSA

“…With the primary indication for RTSA being rotator cuff tear arthropathy, indications for RTSA have expanded beyond conditions affiliated with rotator cuff defects. These include tumor resection [1], revision shoulder arthroplasty from failed TSA procedures [2,3], irreparable rotator cuff tears leading to pseudoparalysis [4], rheumatoid arthritis [5,6], fracture sequelae [7,8], and complex proximal humeral fractures [9].…”