Reverse the Trend for Proximal Humeral Fractures: A Review of the Evidence for the Use of Reverse Shoulder Replacement in Acute Trauma

Abstract

Background

Proximal humeral fractures in the elderly population represent a particularly demanding subset of fractures. These have been traditionally treated with Hemi-arthroplasty (HA). Recently there has been a trend towards using a Reverse shoulder replacement (RSR) in some of these patients. The primary aim of the study was to systematically review the literature on the functional outcome scores for RSR in proximal humeral fractures and compare it with the best quality literature available for HA. Secondarily to compare range of movement, complication rates, re-operation rates and x-ray changes.

Methods

A systematic review of the literature was performed using the keywords: Delta, inverse, shoulder, trauma, and fracture. Only studies with 10 patients or more, presenting new data on the functional outcome scores of RSR for acute trauma were included. Studies reporting the use of RSR for fracture sequalae were excluded. These results were compared to the most comprehensive and up to date literature available for HA for proximal humeral fractures.

Results

Eight papers met the full inclusion and exclusion criteria. Data was available for 178 patients with a minimum follow-up of only 3 months. The mean absolute constant score for RSR patients was 54% and 57% for HA patients. RSR had an infection rate of 3%, a dislocation rate of 4% and an overall re-operation rate of 5.6%.

Conclusion

Functional outcomes and range of movements achieved by RSR seem to be similar to those achieved by HA and may eventually be proven to have better outcomes in a certain sub-group of patients. However, there is currently less than 200 patients reported in the literature with a very short term follow-up. RSR is more expensive than HA, and there is a definite learning curve associated with this prosthesis. Although RSR may be valuable in patients where a traditional HA is deemed not suitable, caution must be used until better quality research is available.

Level of evidence: Level III systematic review of Level III studies

Keywords

Reverse shoulder replacement proximal humeral fractures shoulder trauma.

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References

Murray

, Amin

, White

, Robinson

. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 2011; 93-B: 1–11.

Neer

. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52: 1077–89.

Neer

. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970; 52: 1090–103.

Boileau

, Krishnan

, Tinsi

,. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 2002; 11: 401–12.

Robinson

, Page

, Hill

,. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 2003; 85-A: 1215–23.

Young

, Segal

, Turner

, Poon

. Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. Aust N Z J Surg 2010; 80: 789–93.

Terragnoli

, Zattoni

, Damiani

, Cabrioli

, LiBassi

. Treatment of proximal humeral fractures with reverse prostheses in elderly patients. J Orthop Traumatol 2007; 8: 71–6.

Cazeneuve

, Hassan

, Kermad

, Brunel

. Delta III reverse-ball-and-socket total shoulder prosthesis for acute complex fractures of the proximal humerus in elderly population. Eur J Orthop Surg Traumatol 2008; 18: 81–6.

Milgrom

, Schaffler

, Gilbert

, van

. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br 1995; 77: 296–8.

10.

Gallinet

, Clappaz

, Garbuio

, Tropet

, Obert

. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 2009; 95: 48–55.

11.

Grammont

, Baulot

. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 1993; 16: 65–8.

12.

Guery

, Favard

, Sirveaux

,. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006; 88: 1742–7.

13.

Dawson

, Rogers

, Fitzpatrick

, Carr

. The Oxford shoulder score revisited. Arch Orthop Trauma Surg 2009; 129: 119–23.

14.

Kontakis

, Koutras

, Tosounidis

, Giannoudis

. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br 2008; 90: 1407–13.

15.

Cazeneuve

, Cristofari

. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br 2010; 92: 535–9.

16.

Bufquin

, Hersan

, Hubert

, Massin

. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 2007; 89: 516–20.

17.

Cazeneuve

, Cristofari

. Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 2009; 95: 325–9.

18.

Klein

, Juschka

, Hinkenjann

, Scherger

, Ostermann

. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 2008; 22: 698–704.

19.

Lenarz

, Shishani

, McCrum

,. Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res 2011; 469: 3324–31.

20.

Cazeneuve

, Cristofari

. Long term functional outcome following reverse shoulder arthroplasty in the elderly. Orthop Traumatol Surg Res 2011; 97: 583–9.

21.

Reitman

, Kerzhner

. Reverse shoulder arthoplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop (Belle Mead NJ) 2011; 40: 458–61.

22.

Ladermann

, Lubbeke

, Collin

,. Influence of surgical approach on functional outcome in reverse shoulder arthroplasty. Orthop Traumatol Surg Res 2011; 97: 579–82.

23.

Kralinger

, Schwaiger

, Wambacher

,. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 2004; 86: 217–19.

24.

Kwon

, Zuckerman

. Outcome after treatment of proximal humeral fractures with humeral head replacement. Instr Course Lect 2005; 54: 363–9.

25.

Kempton

, Ankerson

, Wiater

. A complication-based learning curve from 200 reverse shoulder arthroplasties. Clin Orthop Relat Res 2011; 469: 2496–504.