Humeral Head Replacement and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humerus Fracturesm



Aaron Andrew Frombach, Kendra Brett, Peter Lapner*
Division of Orthopaedics, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada


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© 2017 Frombach et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Division of Orthopaedics, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Room W1648, Ottawa, ON, K1H 8L6, Canada; Tel: 613-737-8377; Fax: 613-737-8837; E-mail: plapner@toh.on.ca


Abstract

Acute proximal humeral fractures in the elderly are generally treated non-operatively if alignment is acceptable and in stable fracture patterns. When operative treatment is indicated, surgical fixation is often difficult or impossible to obtain. Hemiarthroplasty has long been the standard of care. However, with its reliance on tuberosity healing, functional outcomes and patient satisfaction are often poor. Reverse shoulder arthroplasty has emerged as a new technology for treating proximal humeral fractures but the indications for its use remain uncertain. While not conclusive, the evidence suggests that reverse shoulder arthroplasty yields more consistent results, with improved forward elevation and higher functional outcome scores. The primary advantages of hemiarthroplasty are improved shoulder rotation and shorter operative time. Complication rates do not vary significantly between the two options. Although higher quality trials are needed to further define the role of reverse shoulder arthroplasty, current evidence suggests that this is a reasonable option for surgeons who are highly familiar with its use.

Keywords: Humeral head replacement, Proximal humerus fracture, Proximal humerus fracture-dislocation, Proximal humerus hemiarthroplasty, Reverse shoulder arthroplasty, Tuberosity.