International Orthopaedics

, Volume 39, Issue 2, pp 335–342 | Cite as

Comparison between reverse shoulder arthroplasty and Humerusblock in three- and four-part proximal humerus fractures in elderly patients

  • Reinhold Ortmaier
  • Georg Mattiassich
  • Matthias Pumberger
  • Wolfgang Hitzl
  • Philipp Moroder
  • Alexander Auffarth
  • Herbert Resch
Original Paper



We set out to compare osteosynthesis using the minimally invasive, semi-rigid, Humerusblock to reverse shoulder arthroplasty (RSA) for primary fracture treatment in three- and four-part fractures in patients over 65 years old.


In the study period from 2008 to 2011, we conducted a matched-pair analysis of 25 patients treated with reverse shoulder arthroplasty (group 1) to 25 patients treated with the Humerusblock (group 2). At the time of follow-up, a complete physical examination of the shoulders, including evaluation with the Constant–Murley score and the VAS pain scale, was performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of malreduction, malunion, nonunion, scapular notching or radiolucent lines around the prosthesis.


After a minimum follow-up of 12 months, the mean CMS differed significantly between groups 1 and 2 (47.4 vs 64.4, p<0.01). The mean abduction (97.6° vs 126.8°, p<0.01), anterior flexion (103.2° vs 139.6°, p<0.01) and external rotation (16° vs 39.6°; p<0.01) were significantly worse in group 1. The VAS pain score was significantly lower in group 2 compared to group 1 (0.92 vs 3.12, p<0.01).


This is the first study that compared the Humerusblock to reverse shoulder arthroplasty for primary fracture treatment. In this study, the functional outcome was superior in the Humerusblock group.


Reverse shoulder arthroplasty Humerusblock Proximal humeral fractures Treatment Arthroplasty Osteosynthesis 


  1. 1.
    Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, Boileau P, de Peretti F (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res: OTSR 98:715–719. doi: 10.1016/j.otsr.2012.05.013 PubMedCrossRefGoogle Scholar
  2. 2.
    Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I (2000) Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand 71:465–470. doi: 10.1080/000164700317381144 PubMedCrossRefGoogle Scholar
  3. 3.
    Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92PubMedCrossRefGoogle Scholar
  4. 4.
    Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am Vol 52:1077–1089Google Scholar
  5. 5.
    Gerber C, Schneeberger AG, Vinh TS (1990) The arterial vascularization of the humeral head. An anatomical study. J Bone Joint Surg Am Vol 72:1486–1494Google Scholar
  6. 6.
    Murray IR, Amin AK, White TO, Robinson CM (2011) Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 93:1–11. doi: 10.1302/0301-620X.93B1.25702 PubMedCrossRefGoogle Scholar
  7. 7.
    Adedapo AO, Ikpeme JO (2001) The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury 32:115–121PubMedCrossRefGoogle Scholar
  8. 8.
    Zhang J, Ebraheim N, Lause GE (2012) Surgical treatment of proximal humeral fracture with external fixator. J Shoulder Elbow Surg 21:882–886. doi: 10.1016/j.jse.2011.07.005 PubMedCrossRefGoogle Scholar
  9. 9.
    Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD (2007) Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 89(Suppl 3):44–58. doi: 10.2106/JBJS.G.00648 PubMedCrossRefGoogle Scholar
  10. 10.
    Bogner R, Hubner C, Matis N, Auffarth A, Lederer S, Resch H (2008) Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br 90:1602–1607. doi: 10.1302/0301-620X.90B12.20269 PubMedCrossRefGoogle Scholar
  11. 11.
    Jost B, Spross C, Grehn H, Gerber C (2013) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 22:542–549. doi: 10.1016/j.jse.2012.06.008 PubMedCrossRefGoogle Scholar
  12. 12.
    Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16:65–68PubMedGoogle Scholar
  13. 13.
    Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am 95:2050–2055. doi: 10.2106/JBJS.L.01637 PubMedCrossRefGoogle Scholar
  14. 14.
    Namdari S, Horneff JG, Baldwin K (2013) Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures: a systematic review. J Bone Joint Surg Am 95:1701–1708. doi: 10.2106/JBJS.L.01115 PubMedCrossRefGoogle Scholar
  15. 15.
    Mata-Fink A, Meinke M, Jones C, Kim B, Bell JE (2013) Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: a systematic review. J Shoulder Elbow Surg 22:1737–1748. doi: 10.1016/j.jse.2013.08.021 PubMedCrossRefGoogle Scholar
  16. 16.
    Resch H, Povacz P, Frohlich R, Wambacher M (1997) Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79:295–300PubMedCrossRefGoogle Scholar
  17. 17.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  18. 18.
    Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131PubMedCrossRefGoogle Scholar
  19. 19.
    Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM (2000) Radiographic assessment of ingrowth total shoulder arthroplasty. J Shoulder Elbow Surg 9:507–513PubMedCrossRefGoogle Scholar
  20. 20.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83PubMedGoogle Scholar
  21. 21.
    Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 85-A:1215–1223PubMedGoogle Scholar
  22. 22.
    Cheung EV, Sperling JW, Cofield RH (2008) Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop Relat Res 466:1363–1367. doi: 10.1007/s11999-008-0226-3 PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Gerber C, Werner CM, Vienne P (2004) Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 86:848–855PubMedCrossRefGoogle Scholar
  24. 24.
    Keener JD, Parsons BO, Flatow EL, Rogers K, Williams GR, Galatz LM (2007) Outcomes after percutaneous reduction and fixation of proximal humeral fractures. J Shoulder Elbow Surg 16:330–338. doi: 10.1016/j.jse.2006.09.006 PubMedCrossRefGoogle Scholar
  25. 25.
    Resch H, Hubner C, Schwaiger R (2001) Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury 32(Suppl 1):SA25–SA32PubMedCrossRefGoogle Scholar
  26. 26.
    Brunner A, Weller K, Thormann S, Jockel JA, Babst R (2010) Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the Humerusblock. J Orthop Trauma 24:407–413. doi: 10.1097/BOT.0b013e3181c81b1c PubMedCrossRefGoogle Scholar
  27. 27.
    Owsley KC, Gorczyca JT (2008) Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am 90:233–240. doi: 10.2106/JBJS.F.01351 PubMedCrossRefGoogle Scholar
  28. 28.
    Spross C, Platz A, Rufibach K, Lattmann T, Forberger J, Dietrich M (2012) The PHILOS plate for proximal humeral fractures-risk factors for complications at one year. J Trauma Care Surg 72:783–792. doi: 10.1097/TA.0b013e31822c1b5b CrossRefGoogle Scholar
  29. 29.
    Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123:74–81. doi: 10.1007/s00402-002-0465-9 PubMedGoogle Scholar
  30. 30.
    Gardner MJ, Nork SE, Huber P, Krieg JC (2010) Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots. Injury 41:652–656. doi: 10.1016/j.injury.2010.02.022 PubMedCrossRefGoogle Scholar
  31. 31.
    Carbone S, Moroder P, Arceri V, Postacchini R, Gumina S (2014) The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock device. Int Orthop. doi: 10.1007/s00264-014-2327-9 PubMedGoogle Scholar
  32. 32.
    Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. doi: 10.1016/j.injury.2011.01.017 PubMedCrossRefGoogle Scholar
  33. 33.
    Roderer G, Erhardt J, Kuster M, Vegt P, Bahrs C, Kinzl L, Gebhard F (2011) Second generation locked plating of proximal humerus fractures-a prospective multicentre observational study. Int Orthop 35:425–432. doi: 10.1007/s00264-010-1015-7 PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191. doi: 10.1097/BOT.0b013e3180333094 PubMedCrossRefGoogle Scholar
  35. 35.
    Gerber C, Lambert SM, Hoogewoud HM (1996) Absence of avascular necrosis of the humeral head after post-traumatic rupture of the anterior and posterior humeral circumflex arteries. A case report. J Bone Joint Surg Am 78:1256–1259PubMedGoogle Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Reinhold Ortmaier
    • 1
  • Georg Mattiassich
    • 2
  • Matthias Pumberger
    • 3
  • Wolfgang Hitzl
    • 4
  • Philipp Moroder
    • 1
  • Alexander Auffarth
    • 1
  • Herbert Resch
    • 1
  1. 1.Unfallchirurgie und SporttraumatologieParacelsus medizinische UniversitätSalzburgAustria
  2. 2.Traumatology DepartmentUnfallkrankenhaus Linz, Lehrkrankenhaus der Paracelsus medizinischen UniversitätLinzAustria
  3. 3.Unfallchirurgie und Muskuloskelettale ChirurgieUniversitätsklinik Charité BerlinBerlinGermany
  4. 4.BiostatistikParacelsus medizinische UniversitätSalzburgAustria

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