Skip to main content

Advertisement

SpringerLink
Log in

Reverse shoulder arthroplasty for proximal humerus fractures: a comparison of the deltoid split and deltopectoral approaches

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Reverse shoulder arthroplasty (RSA) is a common treatment for three- and four-part proximal humerus fractures. RSA is commonly performed through a deltopectoral (DP) surgical approach; however, a deltoid split (DS) approach has been described. The purpose of this study was to compare the intraoperative and postoperative outcomes of patients undergoing RSA for proximal humerus fractures through a DP and DS approach.

Materials and methods

A retrospective study of patients who underwent RSA for proximal humerus fractures at our level 1 trauma center was performed. Patients were evaluated at a minimum 1-year follow-up. Intraoperative outcomes as well as patient-reported outcome measures (PROMs) were analyzed. Postoperative complications, reoperation rates, and radiographic outcomes were evaluated.

Results

Sixteen patients were included in the DP group and 13 patients in the DS group. The average follow-up was 28.6 months in the DP group and 21.1 months in the DS group. There were no significant differences in patient demographics or injury characteristics. Operative time was significantly shorter in the DS group (103 min) compared to the DP group (123 min). Tuberosity repair was performed in 81.3% of patients in the DP group and 92.3% of patients in the DS group. No significant differences were found in PROMs at final follow-up. There were no significant differences in postoperative complications. Three patients in the DP group and one patient in the DS group required reoperation. Lastly, 81.8% of patients achieved tuberosity union in the DS group and 66.7% in the DP group; however, this did not reach statistical significance.

Conclusion

This study demonstrates that RSA for proximal humerus fractures performed through a DS or DP approach may result in similar intraoperative and postoperative outcomes, with no difference in reoperation or complication rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371. https://doi.org/10.1080/000164701753542023

    Article  CAS  PubMed  Google Scholar 

  2. Jobin CM, Galdi B, Oke A, Ahmad, Levine WN. Reverse shoulder arthroplasty for the management of proximal humerus fractures. J Am Acad Orthop Surg. 2015, 23(3):190–201. https://doi.org/10.5435/JAAOS-D-13-00190

  3. Passaretti D, Candela V, Sessa P, Gumina S (2017) Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg 26(12):2117–2124. https://doi.org/10.1016/j.jse.2017.05.029

    Article  PubMed  Google Scholar 

  4. Rajaee SS, Yalamanchili D, Noori N, Debbi E, Mirocha J, Lin CA (2017) Increasing use of reverse total shoulder arthroplasty for proximal humerus fractures in elderly patients. Orthopedics 40(6):e982–e989. https://doi.org/10.3928/01477447-20170925-01

    Article  PubMed  Google Scholar 

  5. Rosas S, Law TY, Kurowicki J, Formaini N, Kalandiak SP, Levy CJ (2016) Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012. J Shoulder Elbow Surg 25(4):608–613. https://doi.org/10.1016/j.jse.2015.08.011

    Article  PubMed  Google Scholar 

  6. Savin DD, Zamfirova I, Iannotti J, Goldberg BA, Youderian AR (2016) 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. Int Orthop 40(9):1919–1925. https://doi.org/10.1007/s00264-016-3227-y

    Article  PubMed  Google Scholar 

  7. Fraser AL, Bjørdal J, Wagle TM, Karlberg AC, Lien OA, Eilertsen L et al (2020) Reverse shoulder arthroplasty is superior to plate fixation at 2 years for displaced proximal humerus fractures in the elderly: a multicenter randomized controlled trial. J Bone Joint Surg Am 102(6):477–485. https://doi.org/10.2106/JBJS.19.01071

    Article  PubMed  Google Scholar 

  8. Grubhofer F, Wieser K, Meyer DM, Catanzaro S, Beeler S, Riede U et al (2016) Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg 25(10):1690–1698. https://doi.org/10.1016/j.jse.2016.02.024

    Article  PubMed  Google Scholar 

  9. Wolfensperger F, Grüninger P, Dietrich M, Völlink M, Benninger E, Schläppi M, etl al. Reverse shoulder arthroplasty for complex fractures of the proximal humerus in elderly patients: impact on the level of independency, early function, and pain medication. J Shoulder Elbow Surg. 2017, 26(8):1462–1468. https://doi.org/10.1016/j.jse.2017.01.021

  10. Wright JO, Ho A, Kalma J, Koueiter D, Esterle J, Marcantonio D et al (2019) Uncemented reverse total shoulder arthroplasty as initial treatment for comminuted proximal humerus fractures. J Orthop Trauma 33(7):e263–e269. https://doi.org/10.1097/BOT.0000000000001465

    Article  PubMed  Google Scholar 

  11. Gerber C, Pennington SD, Nyffeler RW (2009) Reverse total shoulder arthroplasty. J Am Acad Orthop Surg 17(5):284–295. https://doi.org/10.5435/00124635-200905000-00003

    Article  PubMed  Google Scholar 

  12. Lafosse L, Schnaser E, Haag M, Gobezie R. Primary total shoulder arthroplasty performed entirely thru the rotator interval: technique and minimum two-year outcomes. J Shoulder Elbow Surg. 2009, 18(6):864–873. Doi: https://doi.org/10.1016/j.jse.2009.03.017

  13. Mackenzie DB. The antero-superior exposure for total shoulder replacement. Orthop Traumatol. 1993, 2L71–77. https://doi.org/10.1007/BF02620461

  14. Molé D, Wein F, Dézaly C, Valenti P, Sirveaux F (2011) Surgical technique: the anterosuperior approach for reverse shoulder arthroplasty. Clin Orthop Relat Res 469(9):2461–2469. https://doi.org/10.1007/s11999-011-1861-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bhayana H, Chouhan DK, Aggarwal S, Prakash M, Patel S, Arora C, et al. Outcomes of plate osteosynthesis for displaced 3-part and 4-part proximal humerus fractures with deltopectoral vs. deltoid split approach. Eur J Trauma Emerg Surg. 2021. Online ahead of print. https://doi.org/10.1007/s00068-021-01761-6.

  16. Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S (2014) Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop Relat Res 472(5):1576–1585. https://doi.org/10.1007/s1199-013-3415-7

    Article  PubMed  Google Scholar 

  17. Martetschläger F, Siebenlist S, Weier M, Sandmann G, Ahrens P, Braun K et al (2012) Plating of proximal humeral fractures. Orthopedics 35(11):e1606-1612. https://doi.org/10.3928/01477447-20121023-17

    Article  PubMed  Google Scholar 

  18. Rouleau DM, Balg F, Benoit B, Leduc S, Malo M, Vézina F, et al. Deltopectoral vs. deltoid split approach for proximal Humerus fracture fixation with locking plate: a prospective Randomized study (HURA). J Shoulder Elbow Surg. 2020;29(11):2190–2199. Doi: https://doi.org/10.1016/j.jse.2020.06.020

  19. Neer CS. Displaced proximal humeral fratures. I. Classification and evaluation. J Bone Joint Surg Am. 1970 Sep;52(6):1077–1089. PMID: 5455339

  20. Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I et al (2014) The definition of polytrauma revisited: an international consensus process and proposal of the new ‘Berlin definition.’ J Trauma Acute Care Surg 77(5):780–786. https://doi.org/10.1097/TA.0000000000000453

    Article  PubMed  Google Scholar 

  21. Boileau P, Alami G, Rumian A, Schwartz DG, Trojani C, Seidl AJ (2017) The double-suture Nice Knot. Orthopedics 40(2):e382-386. https://doi.org/10.3928/01477447-20161202-05

    Article  PubMed  Google Scholar 

  22. Cetik O, Uslu M, Acar HI, Comert A, Tekdemir I, Cift H (2006) Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study. J Bone Joint Surg Am 88(11):239502399. https://doi.org/10.2106/JBJS.E.01375

    Article  Google Scholar 

  23. Hachadorian ME, Mitchell BC, Siow MY, Wang W, Bastgrom T, Sullivan TB et al (2020) Identifying the axillary nerve during shoulder surgery: an anatomic study using advanced imaging. JSES Int 4(4):987–991. https://doi.org/10.1016/j.jseint.2020.06.011

    Article  PubMed  PubMed Central  Google Scholar 

  24. MacLean SB, Maheno T, Boyle A, Ragg A, Bain GI, Galley I (2021) Defining the proximity of the axillary nerve from defined anatomic landmarks: an in vivo magnetic resonance imaging study. J Shoulder Elbow Surg 30(4):729–735. https://doi.org/10.1016/j.jse.2020.08.005

    Article  PubMed  Google Scholar 

  25. Xie L, Zhang Y, Chen C, Zheng W, Chen H, Cai L (2019) Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: A systematic review and meta-analysis. Orthop Traumatol Surg Res 105(2):307–316. https://doi.org/10.1016/j.otsr.2018.12.004

    Article  PubMed  Google Scholar 

  26. Jiang JJ, Somogyi JR, Patel PB, Koh JL, Dirschl DR, Shi LL (2016) Obesity is not associated with increased short-term complications after primary total shoulder arthroplasty. Clin Orthop Relat Res 474(3):787–795. https://doi.org/10.1007/s11999-015-4584-3

    Article  PubMed  Google Scholar 

  27. Wang KY, Quan T, Best MJ, Gu A, McFarland EG, Srikumaran U (2021) BMI and male gender are associated with increased operative time during total shoulder arthroplasty: an analysis of 16,568 patients. Seminars in Arthroplasty: JSES 31(2):346–352. https://doi.org/10.1053/j.sart.2021.02.007

    Article  CAS  Google Scholar 

  28. Tashjian RZ, Keener JD, McAllister J, Ebersole G, Granger EK, Chen, et al. Determining the minimal clinically important difference (MCID) for the ASES, SST, and VAS pain after total shoulder arthroplasty (TSA). J Shoulder Elbow Surg. 2017;26(1):144–148. Doi: https://doi.org/10.1016/j.jse.2016.06.007

  29. Boileau P, Alta TD, Decroocq L, Sirveaux F, Clavert P, Favard L et al (2019) Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities. J Shoulder Elbow Surg 28(3):437–444. https://doi.org/10.1016/j.jse.2018.08.025

    Article  PubMed  Google Scholar 

  30. Jain NP, Mannan SS, Dharmarajan R, Rangan A et al (2019) Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 28(3):e78–e91. https://doi.org/10.1016/j.jse.2018.09.006

    Article  PubMed  Google Scholar 

  31. Uzer G, Yildiz F, Batar S, Elmadag M, Kus G, Bilsel K (2017) Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty? J Shoulder Elbow Surg 26(1):36–41. https://doi.org/10.1016/j.jse.2016.05.005

    Article  PubMed  Google Scholar 

Download references

Funding

No financial support was received by any of these authors for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, OhioHealth/Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA

    Hayden B. Schuette DO, Craig C. Goubeaux DO & Daniel T. DeGenova DO

  2. Department of Orthopedic Trauma, OhioHealth/Grant Medical Center, Columbus, OH, USA

    Nathaniel J. Starcher BA, Sanjay Mehta MD & Benjamin C. Taylor MD

  3. Department of Orthopedic Surgery, Indiana University Health, Muncie, IN, USA

    Jacob J. Triplet DO

Authors
  1. Hayden B. Schuette DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathaniel J. Starcher BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Craig C. Goubeaux DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel T. DeGenova DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacob J. Triplet DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sanjay Mehta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benjamin C. Taylor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hayden B. Schuette DO.

Ethics declarations

Conflict of interest

Hayden B. Schuette, DO—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Hayden B. Schuette on 06/18/22. Nathaniel J. Starcher, BA—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Nathaniel J. Starcher on 06/18/22. Craig C. Goubeaux, DO—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Craig C. Goubeaux on 06/18/22. Daniel T. DeGenova, DO—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Daniel T. DeGenova on 06/18/22. Jacob J. Triplet, DO—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Jacob J. Triplet on 06/18/22. Sanjay Mehta, MD—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Sanjay Mehta on 06/18/22. Benjamin C. Taylor, MD—This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Electronically signed by Benjamin C. Taylor on 06/18/22.

Institutional review board information

Approved by OhioHealth Corporation Institutional Review Board. Study number 1748069–4.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schuette, H.B., Starcher, N.J., Goubeaux, C.C. et al. Reverse shoulder arthroplasty for proximal humerus fractures: a comparison of the deltoid split and deltopectoral approaches. Arch Orthop Trauma Surg 143, 4663–4669 (2023). https://doi.org/10.1007/s00402-022-04746-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04746-1

Keywords

Search

Navigation