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Review
. 2017 Feb 28:11:108-118.
doi: 10.2174/1874325001711010108. eCollection 2017.

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

Ioannis Gigis  1 , Alexandros Nenopoulos  1 , Dimitrios Giannekas  1 , Roderich Heikenfeld  2 , Theodoros Beslikas  1 , Ippokratis Hatzokos  1
Affiliations
Review

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

Ioannis Gigis et al. Open Orthop J. .

Abstract

Background: Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality. Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.

Methods: We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.

Results: Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure. Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones. However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.

Conclusion: Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

Keywords: Elderly; Fragility; Internal fixation; Reverse shoulder prosthesis; Shoulder hemiarthroplasty; Tuberosities fracture; proximal humerus fractures.

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Figures

Fig. (1)
Fig. (1)
Avascular necrosis and screw penetration of humeral head following plate osteosynthesis of a 4-part proximal humeral fracture.
Fig. (2)
Fig. (2)
Proximal humeral head fracture with extension to the shaft (a) treated with plate osteosynthesis (b).
Fig. (3)
Fig. (3)
X-ray (a) and 3D reconstruction CT (b) of a 4-part humeral head fracture treated with hemiarthroplasty (c).
Fig. (4)
Fig. (4)
X-Ray (a), CT (b) and 3D reconstruction CT (c) of a 4-part humeral head fracture treated with reverse shoulder arthroplasty.
Fig. (5)
Fig. (5)
Dislocation of a reverse shoulder arthroplasty.
See this image and copyright information in PMC

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