Abstract
Objective This study compared functional results in two cohorts of older adults with three-
and four-part proximal humeral fractures (PHFs) per Neer's classification treated
with reverse shoulder arthroplasty (RSA) or nonoperative management.
Materials and Methods Ambispective, non-randomized study with two cohorts of patients aged 75 or older
treated with RSA (n = 15) or nonoperative management (n = 16) with a minimum follow-up
period of 12 months. We analyzed the American Shoulder and Elbow Surgeons (ASES),
Constant-Murley, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and
the visual analog scale (VAS) for pain at 3, 6, and 12 months. In addition, we recorded
radiological findings and surgical complications.
Results The mean Constant-Murley score at 12 months was significantly higher for the RSA
group (75.1 +/- 10.3 vs. 51.9 +/- 12.4, p = 0.001). There were no differences in ASES,
DASH, and VAS scores. Statistically significant differences for flexion and external
rotation in abduction favored the RSA group (128.9 +/- 17.0 versus 99.3 +/- 20.1,
p = 0.001, and 35.7 +/- 13.9 vs. 23.4 +/- 15.5, p = 0.032, respectively). For the
RSA group, tuberosity positioning was correct in 43% of subjects. These patients presented
better scores than those with malpositioned or absent tuberosities but with no statistical
significance. Complications in the surgical group were not higher.
Conclusions Nonoperative treatment is a valid option regarding pain and functionality in elderly
patients with three- and four-part PHFs. Characteristics of patients with high demands
who may be candidates for the initial surgical treatment remain to be defined.
Level of Evidence Level III
Keywords
proximal humeral fracture - elderly - nonoperative treatment - reverse shoulder arthroplasty
