Reverse Shoulder Prosthesis for Proximal Humeral Fractures: Primary Treatment vs. Salvage Procedure

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Musculoskeletal Research

Background:

• Optimal treatment for complex proximal humerus fractures (PHFs) remains debated.
• Reverse total shoulder arthroplasty (RTSA) is often a secondary treatment option.
• Lack of consensus exists regarding primary versus salvage RTSA for PHFs.

Purpose of the Study:

• To compare clinical outcomes and patient satisfaction between primary RTSA and salvage RTSA for PHFs.
• To evaluate functional scores and range of motion (ROM) in both treatment groups.
• To assess complication rates associated with primary versus salvage RTSA.

Main Methods:

• Retrospective analysis of 63 patients undergoing RTSA between 2011 and 2021.
• Comparison of primary RTSA for PHFs versus salvage RTSA for failed osteosynthesis.
• Minimum two-year clinical and radiological follow-up, assessing ROM and Constant shoulder score.

Main Results:

• Primary RTSA group (n=42) showed significantly better forward flexion, abduction, and internal rotation compared to salvage RTSA (n=21).
• The Constant shoulder score was significantly higher in the primary RTSA group.
• Complication rates were lower in primary RTSA (7.15%) versus salvage RTSA (14.28%), though patient satisfaction was similar.

Conclusions:

• Primary RTSA for complex PHFs may offer superior functional outcomes and a lower complication profile than salvage RTSA.
• While patient satisfaction was comparable, functional improvements favor primary RTSA.
• Further prospective research is warranted to confirm these findings and guide treatment decisions.