Locking Plate Fixation with Cemented Screws versus Delta Xtend Reverse Shoulder Arthroplasty for Complex Proximal...

Due to the high complication rates associated with open reduction and internal fixation using locking plates (ORIF-LP) for complex proximal humerus fractures (PHFs) in elderly patients, many authors consider reverse shoulder arthroplasty (rTSA)the treatment of choice. However, the use of cemented screws in locked plating (ORIF-LPc) has been suggested to reduce implant-related complications. The aim of this matched-pair study was to compare clinical and radiographic outcomes, complication and revision surgery rates in patients older than 65 years with complex PHFs treated with cement-augmented locking plate fixation or reverse shoulder arthroplasty.

Patients older thant 65 years with complex PHFs who underwent an ORIF-LPc (Philos, DePuy Synthes) were matched 1:1 with patients treated with Delta Xtend rTSA (DePuy Synthes, Warsaw, IN, USA) at a single institution between 2014 and 2023. Exclusion criteria included neurological injury, pathological or open fractures, absence of preoperative CT scan, and follow-up of less than 2 years. Fractures were classified according to the Mayo-FJD Classification. Clinical follow-up was conducted at 6 weeks, and at 3, 6, and 12 months, followed by annual assessments. Demographic data, range of motion, Constant Score (CS), Subjective Shoulder Value (SSV), pain with Visual Analog Scale (VAS), EuroQol-5D scores (EQ-5D), complication rates, and revision surgeries were analyzed. The mean follow-up was 4.7 ± 2.2 years (range 2.1-12.8 years). A p-value < 0.05 was considered statistically significant.

A total of 86 patients were included, with 43 patients in each group. The mean age was 75±7 years, 93% were female and 48% had dominant-side involvement. Patients treated with ORIF-LPc demonstrated significantly greater external rotation (49°±21° vs. 27°±19°, p<0.001) and internal rotation (median internal rotation: sacroiliac joint vs waist, p<0.001). No significant differences were observed in forward elevation (130°±37° vs. 136°±28°, p=0.634), CS (p=0.672), pain (p=0.704), or EuroQol-5D (EQ-5D) scores (p=0.25). No statistically significant differences were observed in complication rates (21% ORIF-LPc vs. 18.6% rTSA, p = 1.000) or revision surgery rates (7% ORIF-LPc vs. 9% rTSA, p = 1.000).

Both ORIF-LPc and Delta Xtend reverse shoulder arthroplasty were associated with satisfactory clinical outcomes. ORIF-LPc provided greater external and internal rotation, whereas no statistically significant differences were observed in overall functional outcomes, complication rates, or revision rates.