Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures-A Retrospective Cohort Study

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomaterials Science

Background:

• Head-split fractures are rare but complex proximal humerus fractures (PHF) involving the articular surface.
• Surgical management of these injuries is challenging, often leading to high complication rates.
• Primary reverse shoulder arthroplasty (RSA) has shown potential for treating PHF, with moderate complication rates and reproducible outcomes.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of reverse shoulder arthroplasty (RSA) for head-split proximal humerus fractures (PHF).
• To assess complication rates associated with RSA in this specific fracture pattern.

Main Methods:

• Retrospective evaluation of 26 patients treated with RSA for head-split PHF.
• Clinical assessment included Constant Score (CS), Subjective Shoulder Value (SSV), and range of motion.
• Radiographic analysis focused on tuberosity healing, prosthetic loosening, and scapular notching.

Main Results:

• Patients achieved good functional outcomes: mean CS of 73.7, mean SSV of 82%, and relative CS of 92% compared to the unaffected shoulder.
• Greater tuberosity healing occurred in 61% of cases; no prosthetic loosening was observed.
• Complication rate was 8%, with scapular notching in two patients. High-energy trauma correlated with better functional outcomes, while multifragmentation led to poorer results.

Conclusions:

• Reverse shoulder arthroplasty (RSA) provides adequate clinical results and acceptable complication rates for head-split proximal humerus fractures (PHF) in elderly patients.
• RSA demonstrates effectiveness in restoring function and achieving tuberosity healing in this challenging fracture type.