Early Versus Late Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Does It Matter

Background: This study compared the outcomes between patients with proximal humerus fractures (PHF) whounderwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatmentbefore requiring (secondary) RSA.Methods: Patients who underwent RSA after suffering a PHF were identified. Two year clinical follow-up was requiredfor inclusion. Patients were divided into an acute group (RSA secondary RSA group was subdivided by initial treatment (non-operative, hemiarthroplasty, open reduction internalfixation (ORIF)). Clinical and radiographic outcomes were compared.Results: Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group.The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). Theacute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosityhealing rate was higher in the acute RSA group.Conclusion: While acute and secondary RSA can yield successful outcomes, acute RSA results in a higher tuberosityhealing rate and improved external rotation.

Keywords:

Hemiarthroplasty , Non-operative treatment , Open reduction internal fixation , Proximal Humerus Fracture , Proximal Humerus Fracture Sequelae , Reverse shoulder arthroplasty , Tuberosity healing