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Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly.

Methods

We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up.

Results

Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%.

Conclusion

In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient’s quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.

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This manuscript was not supported financially by any funding agency.

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Authors and Affiliations

  1. Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy

    P. Luciani, R. Procaccini, M. Rotini, F. Pettinari & A. Gigante

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  1. P. Luciani
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  2. R. Procaccini
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  3. M. Rotini
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  4. F. Pettinari
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  5. A. Gigante
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Contributions

All authors contributed to the study conception and design. Pierfrancesco Luciani and Francesco Pettinari collected the patient data. Roberto Procaccini performed the surgeries. Marco Rotini and Pierfrancesco Luciani analyzed the patient data. Antonio Gigante supported Pierfrancesco Luciani and Marco Rotini with analyzing and interpreting the data. Francesco Pettinari wrote the manuscript. All authors helped write the manuscript and have read and approved the final version.

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Correspondence to P. Luciani.

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This study was approved by the institutional review board and performed in accordance with 1964 Helsinki Declaration.

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Informed consent was obtained from all individual participants included in the study.

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Luciani, P., Procaccini, R., Rotini, M. et al. Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient. Musculoskelet Surg 106, 43–48 (2022). https://doi.org/10.1007/s12306-020-00669-5

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  • DOI: https://doi.org/10.1007/s12306-020-00669-5

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