Comparison between reverse shoulder arthroplasty and Humerusblock in three- and four-part proximal humerus fractures in elderly patients

Abstract

Purpose: We set out to compare osteosynthesis using the minimally invasive, semi-rigid, Humerusblock to reverse shoulder arthroplasty (RSA) for primary fracture treatment in three- and four-part fractures in patients over 65 years old.

Methods: In the study period from 2008 to 2011, we conducted a matched-pair analysis of 25 patients treated with reverse shoulder arthroplasty (group 1) to 25 patients treated with the Humerusblock (group 2). At the time of follow-up, a complete physical examination of the shoulders, including evaluation with the Constant-Murley score and the VAS pain scale, was performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of malreduction, malunion, nonunion, scapular notching or radiolucent lines around the prosthesis.

Results: After a minimum follow-up of 12 months, the mean CMS differed significantly between groups 1 and 2 (47.4 vs 64.4, p<0.01). The mean abduction (97.6° vs 126.8°, p<0.01), anterior flexion (103.2° vs 139.6°, p<0.01) and external rotation (16° vs 39.6°; p<0.01) were significantly worse in group 1. The VAS pain score was significantly lower in group 2 compared to group 1 (0.92 vs 3.12, p<0.01).

Conclusions: This is the first study that compared the Humerusblock to reverse shoulder arthroplasty for primary fracture treatment. In this study, the functional outcome was superior in the Humerusblock group.