Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: a review of the literature

Abstract

Proximal humeral fractures are frequently encountered in the elderly population. While the majority of these fractures can be managed nonoperatively, 2-, 3-, and 4-part fractures, head splitting, and complex fracture dislocations typically require operative management. Open reduction and internal fixation (ORIF) is a popular treatment option for displaced fractures. Advent of locking plates potentially imparts a better option for patients with osteoporotic bone. Hemiarthroplasty has traditionally been used in proximal humeral fractures not amendable to ORIF. While typically providing good pain control, results of hemiarthroplasty have demonstrated inconsistent shoulder motion. Tuberosity malposition or poor healing is a major culprit in unsatisfactory postoperative range of motion. Reverse shoulder arthroplasty has been used in the setting of rotator cuff arthropathy with successful results. Reverse shoulder arthroplasty has recently been used in the setting of acute proximal humeral fractures of the elderly individuals. This technology has shown promising results with mean active anterior elevation from 97° to 122° reported with complication rates of 15% to 28% in short-term studies. Long-term studies and higher level evidence studies with comparison to hemiarthroplasty and ORIF are needed.

Keywords: fragility fractures; geriatric trauma; physical therapy; trauma surgery; upper extremity surgery.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Anteroposterior and axillary lateral radiographs of right shoulder of an 86-year-old male patient. The patient lives alone and is independent with the activities of daily living.

Figure 2.

Computed tomography scan of the right shoulder of the patient from Figure 1 reveals a comminuted head splitting proximal humeral fracture.

Figure 3.

Three-dimensional reconstruction of computed tomography scan from Figure 2.

Figure 4.

Because of the head splitting nature of the fracture seen in Figures 1 to 3 and the high risk of osteonecrosis the patient underwent reverse shoulder arthroplasty. The tuberosities were fixed with nonabsorbable suture. Six-month postoperative radiographs.

Figure 5.

Clinical active range of motion 1 year after reverse shoulder arthroplasty in the patient from Figures 1 to 4