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Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
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Reverse Total Shoulder Arthroplasty for Failed Osteosynthesis in Proximal Humerus Fractures: Outcomes and Challenges
Luís B Pinto1, João Alves2, Eduardo Ferreira2
1Orthopaedics, Unidade Local de Saúde de Viseu Dão-Lafões, Viseu, PRT.
Cureus
|February 16, 2026
Summary
Reverse total shoulder arthroplasty (RTSA) effectively treats complex proximal humerus fractures (PHF) after failed osteosynthesis. This salvage procedure offers significant pain relief and functional improvement in patients with persistent dysfunction.
Area of Science:
- Orthopedic Surgery
- Traumatology
Background:
- Proximal humerus fractures (PHF) are common, especially in the elderly, often treated conservatively but requiring surgery for displaced fractures.
- Reverse total shoulder arthroplasty (RTSA) is increasingly used for complex PHF, but its role after failed osteosynthesis is less understood.
Purpose of the Study:
- To evaluate the effectiveness of RTSA as a salvage procedure for proximal humerus fractures (PHF) with failed osteosynthesis.
Main Methods:
- A retrospective study of nine patients who underwent RTSA for failed PHF osteosynthesis between 2018-2023.
- Data collected included demographics, initial fracture patterns, failure mechanisms, and functional outcomes (Constant Score, VAS, AROM) at minimum 12-month follow-up.
Main Results:
- The cohort, predominantly female (mean age 67), experienced failures from varus collapse, screw/nail pull-out, avascular necrosis, and non-union.
- Post-RTSA, mean AROM improved significantly, Constant Score rose from 35 to 88, and VAS pain scores decreased from 7 to 3.
- One case of postoperative dislocation occurred; mean follow-up was 27 months.
Conclusions:
- RTSA serves as an effective salvage option for failed proximal humerus fracture osteosynthesis, yielding substantial pain reduction and functional recovery.
- Poor bone quality and calcar comminution are potential risk factors for initial fixation failure, highlighting the need for precise primary osteosynthesis.
