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Survey study suggests that reverse total shoulder arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly

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Abstract

Purpose

The role of reverse total shoulder arthroplasty (RTSA) for three and four-part proximal humerus fractures is evolving. However, there does not appear to be a clear consensus amongst surgeons. The purpose of this study is to further define the standard of care, assessing surgeon preference and treatment considerations for management of such fractures.

Methods

Orthopaedic surgeons were surveyed on their training, practice setting, and experience regarding management of four-part proximal humerus fractures. The survey also presented five representative cases to assess treatment preferences.

Results

Two hundred five surgeons responded to the survey with fellowship training in shoulder and elbow surgery (114), orthopaedic trauma (35) or sports medicine/other training (56). There was no difference between respondents with years in practice and confidence with performing RTSA, however, surgeons in the academic setting were more confident in performing the surgery. Surgeons preferred RTSA for management of four-part fractures in patients over age 65. However, they also trended to favour hemiarthroplasty with higher co-morbidities. Physicians with more than 11 years of experience were more likely to choose hemiarthroplasty for older and high comorbidity patients. RTSA was not the preferred treatment method for younger, active patients. Patient age and fracture pattern had a greater influence on the surgeon’s decision.

Conclusions

There is a consensus in our study population that RTSA is the preferred treatment for four-part proximal humerus fractures for elderly patients with patient age and fracture pattern being the most important factors in making management decisions.

Level of Evidence

Level III - Case controlled study

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Acknowledgments

The authors would like to thank Suela Sulo at the James R. & Helen D. Russell Institute for Research & Innovation for her assistance with statistical analysis. We would also like to thank Matthew Siljander MD for his assistance with survey generation and distribution. The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payment or other benefits from any commercial entity related to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, Room E270, M/c 844, Chicago, IL, 60612, USA

    David D. Savin & Benjamin A. Goldberg

  2. Center for Advance Care, Russell Institute for Research and Innovation, 1700 Luther Lane. STE 1410, Park Ridge, IL, 60068, USA

    Ina Zamfirova

  3. Cleveland Clinic Main Campus, Mail Code A41 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Joseph Iannotti

  4. South County Orthopedic Specialists, 24331 El Toro Road #200, Laguna Woods, CA, 92637, USA

    Ari R. Youderian

Authors
  1. David D. Savin
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  2. Ina Zamfirova
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  3. Joseph Iannotti
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  4. Benjamin A. Goldberg
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  5. Ari R. Youderian
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Correspondence to David D. Savin.

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Savin, D.D., Zamfirova, I., Iannotti, J. et al. Survey study suggests that reverse total shoulder arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly. International Orthopaedics (SICOT) 40, 1919–1925 (2016). https://doi.org/10.1007/s00264-016-3227-y

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  • DOI: https://doi.org/10.1007/s00264-016-3227-y

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