Improving Accuracy in Reverse Total Shoulder Arthroplasty for Acute Proximal Humerus Fractures Using Virtual Surgical...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Surgical Planning

Background:

• Reverse total shoulder arthroplasty (rTSA) is a key treatment for complex proximal humerus fractures in elderly patients.
• Accurate humeral stem placement is critical but challenging in these fractures, potentially causing complications.
• Virtual surgical planning (VSP) may optimize implant positioning, but its impact on fracture-related rTSA is unevaluated.

Purpose of the Study:

• To evaluate the clinical impact of VSP on postoperative range of motion (ROM) after rTSA for proximal humerus fractures.
• To assess if VSP improves humeral stem and greater tuberosity positioning.
• To compare ROM, complications, and procedural accuracy between VSP and non-VSP groups.

Main Methods:

• A comparative cohort study included a prospective VSP group and a retrospective non-VSP control group.
• Patients underwent rTSA for proximal humerus fractures.
• Primary outcomes: ROM (forward elevation, abduction, external rotation) at 2 months and 1 year. Secondary outcomes: complications, procedure time, tuberosity healing, stem height deviation.

Main Results:

• The VSP group showed significantly greater abduction at two months (76° vs. 63°, p=0.05).
• Forward elevation and external rotation were numerically higher in the VSP group but not statistically significant.
• Humeral stem height deviation was significantly lower in the VSP group (3 mm vs. 12 mm, p<0.001).

Conclusions:

• VSP facilitates more accurate humeral stem positioning in rTSA for proximal humerus fractures.
• While not leading to statistically significant ROM improvements at one year, VSP enhances surgical accuracy.
• VSP shows promise for optimizing outcomes in complex fracture cases requiring rTSA.