Reverse Shoulder Arthroplasty as Treatment for Comminuted Proximal Humeral Fractures in Elderly Patients

The results of hemiarthroplasty as treatment for com­minuted humerus fractures are poor in elderly patients. While hemiarthroplasty is also an unreliable treatment for rotator cuff tear arthropathy, reverse shoulder arthroplasty (RSA) has been a reliable salvage procedure. The present study examines the result of RSA as treatment for com­minuted proximal humeral fractures in elderly patients.

Thirteen elderly patients underwent RSA for com­minuted proximal humeral fractures. Follow-up ranged from 8 months to 46 months. Patients were assessed retrospectively for Constant-Murley score, rate of complications, and postoperative radiographic review, and data were compared to historical controls.

Mean Constant-Murley score was 67 points (range, 45-77 points). No dislocations occurred. Two patients sustained a postinjury auxiliary nerve palsy, one of which resolved only partially. One patient sus­tained a postinjury radial nerve palsy that resolved. One patient underwent evacuation of a postopera­tive wound hematoma. No shoulder needed revision.

RSA should be considered a salvage procedure, whether performed for cuff tear arthropathy or severe proximal humerus fracture. Even so, RSA can provide immediate shoulder stability for elderly patients with severe shoulder injuries, and results compare favor­ably to historical controls for hemiarthroplasty in these patients.