gms | German Medical Science

Objectives: Fractures of the proximal humerus are among the most common fractures in elderly patients. In these patients, the preservation of an independent life is the most important goal among others such as function, pain control and a low complication rate. Established surgical techniques frequently fail in this patient group due to poor bone quality, avascular head necrosis, and loss of function of the rotator cuff. Reversed shoulder arthroplasty (RSA) may overcome some of these problems. Thus, it was the aim of this study to evaluate RSA as the primary treatment option for complex fractures of the proximal humerus in a group of independent elderly patients.

Methods: Between 01/2012 and 04/2014 all patients treated with RSA have been included in this prospective consecutive case series. Patients with an age > 65 years, an independent life, pre-existing rotator cuff lesions and/or a fracture pattern with a high risk for avascular necrosis of the humeral head were evaluated for primary RSA. Patients treated with revision RSA after failed osteosynthesis or anatomical shoulder hemiarthroplasty were excluded. Postoperative complications and the level of independency and analgesic intake in respect to the preoperative status were evaluated. Follow-up included x-ray investigation, the Constant-Murley score (CMS), the DASH score and the SF-36 score after one year.

Result: We enrolled 39 consecutive patients in this study. Mean age was 78 years. One complication could be recorded, which comprised a postoperative sensomotor neuropathy of the ulnar nerve. One patient was lost to follow-up. After one year, the mean CMS as well as the objective part of its subscores demonstrated a similar shoulder function compared to the opposite side (absolute CMS 71, age- and gender-adapted CMS 104%, 86% of opposite side). The DASH score was measured at a mean of 30 points. The SF-36 score demonstrated an average quality of life comparable to others in this age group. All but one patients had an unchanged level of analgesic intake and were able to return home, where 10% needed more support than they had before the operation.

Conclusion: In our series, RSA for complex fractures of the proximal humerus was associated a very good functional and social outcome. It should therefore seriously be considered for fracture treatment also and especially in the very old group of patients in which a pain free function of the shoulder and a one-time surgery with almost no need for revision surgery is the ambitious aim.