Reverse total shoulder arthroplasty for proximal humerus fractures: Primary or delayed after failed treatment?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Reverse total shoulder arthroplasty (RTSA) is an emerging treatment for proximal humerus fractures (PHFs).
• RTSA also serves as a salvage procedure following failed treatments.

Purpose of the Study:

• To compare the clinical outcomes of primary RTSA versus delayed RTSA in treating displaced PHFs.
• To evaluate functional recovery and complication rates between the two RTSA approaches.

Main Methods:

• Retrospective cohort study of 70 patients with PHFs treated between 2013-2021.
• Comparison of primary RTSA (n=41) versus delayed RTSA (n=29) after failed conservative treatment or osteosynthesis.
• Analysis of complications, active range of motion, and functional outcomes (Q-DASH, Oxford Shoulder scores) using logistic regression.

Main Results:

• No significant differences in fracture type, ASA score, or complication rates between primary and delayed RTSA.
• Primary RTSA showed significantly better Q-DASH (31.4 vs 49.8) and Oxford Shoulder scores (27.5 vs 37.2).
• Primary RTSA resulted in greater flexion (96.8° vs 72.9°) and abduction (94.1° vs 69.3°) compared to delayed RTSA.

Conclusions:

• Primary RTSA for PHFs leads to improved functional outcomes and range of motion.
• Delayed RTSA is a viable option but with less favorable functional results.
• Complication and reintervention rates are comparable between primary and delayed RTSA.