Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012

Rosas, Samuel; Law, Tsun Yee; Kurowicki, Jennifer; Formaini, Nathan T.; Kalandiak, Steven P.; Levy, Jonathan C.

doi:10.1016/j.jse.2015.08.011

Cited by 80 publications

(43 citation statements)

References 19 publications

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“…1,3,5,12,16,23,28 Therefore, a current trend from hemiarthroplasty toward RTSA is reported for complex humeral fractures in the elderly. 38 RTSA yields better functional outcomes and a lower complication rate than hemiarthroplasty in the treatment of complex fractures of the proximal humerus in the elderly. Furthermore, failed hemiarthroplasties can successfully be revised with RTSA.…”

Section: Discussionmentioning

confidence: 94%

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Grubhofer

Wieser

Meyer

et al. 2016

Journal of Shoulder and Elbow Surgery

132

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Due to the aging population with poor bone quality the frequency of complex proximal humerus fractures increases. An operative reconstruction and internal fixation is very challenging and is not always possible. Secondary impaction, screw perforations and humeral head necrosis is a common complication. The use of a Reverse Total Shoulder Arthroplasty in the elderly after trauma is a promising alternative. The present multicenter study retrospectively analyzes our long-term experience of reverse total shoulder arthroplasty as a primary treatment in this patient population regarding pain, range of shoulder motion, subjective shoulder value, the constant score, scapular notiching and signs of loosening. Background: Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Methods: Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). Results: There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. Conclusion:The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Level of evidence: Level IV; Case Series; Treatment Study

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Section: Discussionmentioning

confidence: 94%

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Grubhofer

Wieser

Meyer

et al. 2016

Journal of Shoulder and Elbow Surgery

132

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“…RSA has gained popularity and has showed promising results in the treatment for proximal humeral fractures in the elderly patients 14,31,32 . A recent large database analysis of 32.150 shoulders underlined the growing importance of RSA in treating proximal humeral fractures in elderly, stating that from 2009 to 2012 the utilization rate of RSA nearly tripled for patients over 65 years old, passing from 11% to 29% of treatment choices, to the disadvantage of HA and a steady trend of ORIF 33 .…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients

Giardella

Ascione

Mocchi

et al. 2017

MLTJ

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SummaryBackground: Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation. The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly.

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“…2,4,16,[21][22][23]26 Rates of RTSA have increased exponentially over the past decade, 8,17 and RTSA now comprises approximately one-third of all glenohumeral arthroplasty procedures and roughly one-fourth of arthroplasty-treated proximal humerus fractures. 20 This success has resulted in the rapid expansion of RTSA indications and application.…”

mentioning

confidence: 99%

Previous Rotator Cuff Repair is Associated with Inferior Clinical Outcomes after Reverse Total Shoulder Arthroplasty

Shields

Koueiter

Maerz

et al. 2018

Journal of Shoulder and Elbow Surgery

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Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012

Cited by 80 publications

References 19 publications

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients

Previous Rotator Cuff Repair is Associated with Inferior Clinical Outcomes after Reverse Total Shoulder Arthroplasty

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