Treatment of proximal humeral fractures with reverse prostheses in elderly patients

Fractures of the humeral head account for about 5% of all skeletal fractures and they occur mainly in elderly persons. About 25% of these fractures are dislocated and require open surgical treatment. Fractures in three or four parts (Neer's classification) often have a poor prognosis when synthesized with internal fixation. Furthermore, treatment with hemiarthroplasty does not ensure good results, especially in elderly patients, due to the bad quality of the rotator cuff. We report preliminary results following our choice to use the non-cemented reverse shoulder prosthesis (SMR Modular Shoulder System, Lima-LTO, Italy) in the treatment of three- and four-part fractures of the proximal humerus. We implanted 18 SMR prostheses for such fractures, in patients with mean age 75.2 years. In all cases the rotator cuff was very weak or absent and a biceps tenodesis was performed. This treatment aims at achieving pain relief and a sufficient functional restoration in very elderly patients. The use of a reverse shoulder prosthesis makes it possible to minimize the arm immobilisation and to start functional rehabilitation immediately. We followed up the patients after 3 and 6 months and the results were clinically and radiographically evaluated, using the Constant score and the simple shoulder test. Even considering the limited number of cases and the short follow-up, results appear good with regard to pain and good/sufficient with regard to functional.