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

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.

Fig. (1)

A) plain xrays of comminuted acute proximal humerus fracture-dislocation. Note comminution of tuberosities and humeral head displacement with minimal calcar remaining. B) AP of post-operative day one humeral head replacement showing dislocation of prosthesis from glenoid. C) Six month post-operative follow-up AP imaging following revision to reverse total shoulder arthroplasty. Patient was doing functionally well with no complaints of pain and range of motion continuing to improve.