Fracture Sequelae after Proximal Humerus Fractures - Clinical Outcome of Joint-Preserving Corrective Osteotomy versus...

Due to the distinctive heterogeneity of the functional and biomechanical effects of posttraumatic fracture sequelae subsequent to proximal humerus fractures, there are no validated therapy guidelines yet and the majority of existing studies have concentrated on endoprosthetic treatment options. This retrospective clinical study which directly compares the functional outcome of patients after corrective osteotomy and osteosynthesis with that of patients treated with reverse total shoulder arthroplasty was therefore needed to demonstrate that the functional outcome after joint-preserving treatment provides better results, as shown by the Constant score and range of motion, and identifies the specific criteria relevant for treatment decision-making with a focus on joint preservation.Clinical follow-up examinations were performed after the respective revision surgeries and information was collected about patients' postoperative status (e. g. rating scale for pain, range of motion). Postoperative function was evaluated and analyzed using standardized shoulder scores (Constant score, Simple Shoulder Test, Subjective Shoulder Value).A total of 29 patients were enrolled, with 11 receiving joint-preserving treatment (group A) and 18 treated with arthroplasty (group B). Follow-up examinations were carried out at 38.3 ± 30.2 months after revision surgery. In addition to the higher satisfaction level in group A, lower levels of pain, and a higher range of motion, the Constant score (71.4 ± 11.6 points vs. 54.1 ± 15.3 points, p = 0.008), the Simple Shoulder Test (80.3 ± 16.8 % vs. 54.6 ± 28.3 %, p = 0.011) and the Subjective Shoulder Value (75.5 ± 15.4 % vs. 58.1 ± 20.9 %, p = 0.021) each demonstrated significantly better results for group A.These findings showed better clinical outcomes after joint-preserving therapy, which suggests that it is the better treatment option. Patients < 60 years of age with good bone quality, intact rotator cuff muscles, and a respective patient individually functional entitlement benefit from a joint-preserving approach, which should consequently be the preferred treatment option. For patients > 60 years of age, however, secondary endoprosthetic treatment of fracture sequelae is still indicated, due to progressively degenerative lesions of the rotator cuff muscles and/or of the glenohumeral joint itself in this age group.