FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES

E.L. Flatow

doi:10.1302/1358-992X.2019.8.002

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General Orthopaedics

FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES

The Current Concepts in Joint Replacement (CCJR) Spring 2018 Meeting, Las Vegas, NV, USA, 20–23 May 2018.

E.L. Flatow

FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES

Flatow E. FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES. Orthop Procs. 2019;101-B(SUPP_8):2-2. doi:10.1302/1358-992X.2019.8.002

Flatow, E.L.. “FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES.” Orthopaedic Proceedings, vol. 101-B, no. SUPP_8, 2019, pp. 2-2., https://doi.org/10.1302/1358-992X.2019.8.002

Flatow, E. (2019). FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES. Orthopaedic Proceedings, 101-B(SUPP_8), 2-2. https://doi.org/10.1302/1358-992X.2019.8.002

Flatow, E. (2019) “FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES.” Orthopaedic Proceedings, 101-B(SUPP_8), pp. 2-2. Available at: https://doi.org/10.1302/1358-992X.2019.8.002

Flatow, E.L. “FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES.” Orthopaedic Proceedings 101-B, no. SUPP_8 (2019): 2-2. https://doi.org/10.1302/1358-992X.2019.8.002

Flatow E. FOUR-PART FRACTURES IN AN ACTIVE 65-YEAR-OLD: REVERSE IS THE PREFERRED TREATMENT – OPPOSES. Orthop Procs. 2019 May 1;101-B(SUPP_8):2-2. https://doi.org/10.1302/1358-992X.2019.8.002

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Abstract

Displaced proximal humerus fractures remain a difficult clinical problem, and techniques as diverse as percutaneous pinning, locked plating, intramedullary nailing, and shoulder arthroplasty have been proposed. In recent years, reverse total shoulder arthroplasty (RTSA) has become a very popular option to fix just about any fracture. However, RTSA is not without risk, with complications ranging from infection, instability, acromial stress fractures, aseptic loosening, notching and more. In a 2017 study on 39 patients, Tokish et al. compared non-operative treatment to reverse shoulder arthroplasty for displaced 3- and 4-part fractures. There was no difference in pain, range of motion or outcome scores between the two groups. Among the patients who underwent RTSA, there was no difference between early (<30 days) and late (>30 days) surgery suggesting that it could be safe to attempt a non-operative trial in most patients and see how they do. This is also supported by a 2016 study by Sanchez-Sotelo et al. in which they compared 18 patients with primary RTSA to 26 patients with failed ORIF who underwent salvage RTSA. There was no difference in ASES score, ROM and overall satisfaction between both groups suggesting that an ORIF can be attempted in many patients without the fear of compromising a revision RTSA. And although RTSA may provide more predictable results, in a properly selected patient, a well-executed hemiarthroplasty can outperform an RTSA. In a study from Molé et al., 38 patients were randomised to either RTSA or to a hemiarthroplasty. In the hemiarthroplasty group, half of the patients had <90 degrees of forward elevation and half the patients had >120 degrees of forward elevation showing a bi-modal distribution dependent on tuberosity healing. In the RTSA group, however, while having an average of 115 degrees of forward elevation, 68% of patients had less than 120 degrees of forward elevation. While RTSA is a great tool to treat complex displaced comminuted fractures in elderly patients with poor bone quality, it should not be blindly applied to all fractures types and all patients.