Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults

Background The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcome...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2017-06, Vol.26 (6), p.1017-1022
Main Authors: Roberson, Troy A., MD, Granade, Charles M., PharmD, Hunt, Quinn, BS, Griscom, James T., BS, Adams, Kyle J., BS, Momaya, Amit M., MD, Kwapisz, Adam, MD, Kissenberth, Michael J., MD, Tolan, Stefan J., MD, Hawkins, Richard J., MD, Tokish, John M., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Arthroplasty, Replacement, Shoulder - methods
complications
Conservative Treatment - methods
Female
Fracture Fixation - methods
Humans
Male
Middle Aged
nonoperative treatment
older adult
Orthopedics
Patient Reported Outcome Measures
patient-reported outcomes
Proximal humeral fracture
Range of Motion, Articular
Retrospective Studies
reverse shoulder arthroplasty
Shoulder Fractures - therapy
Shoulder Joint - injuries
Shoulder Joint - physiopathology
Shoulder Joint - surgery
Treatment Outcome
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Summary:Background The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups. Methods A retrospective review was performed on all 3- and 4-part proximal humeral fractures treated with either RSA or nonoperative treatment with minimum 1-year follow-up. All patients in the nonoperative cohort were offered RSA but declined. Objective patient data were obtained from medical records. Patient-reported outcomes including visual analog scale score, Single Assessment Numeric Evaluation score, Penn Shoulder Score, American Shoulder and Elbow Surgeons score, resiliency score, and Veterans Rand-12 scores were obtained at follow-up. Statistical analysis was performed by use of the Student t test for continuous variables and χ2 analysis for nonparametric data. Results We analyzed 19 nonoperative and 20 RSA patients with a mean follow-up period greater than 2 years (29 months in nonoperative group and 53 months in RSA group). There were no differences in range of motion between groups (forward elevation, 120° vs 119° [ P  = .87]; external rotation, 23° vs 31° [ P  = .06]). No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes. Among patients receiving RSA, there was no difference in outcomes in those undergoing surgery less than 30 days after injury versus those receiving delayed RSA. Conclusions This study suggests that there are minimal benefits of RSA over nonoperative treatment for 3- and 4-part proximal humeral fractures in older adults.
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2016.10.013