124.
Reverse shoulder arthroplasty in acute fractures of the proximal
humerus: a systematic review
Stig Brorson, Jeppe V. Rasmussen, Bo S. Olsen, Lars H. Frich, Steen L.
Jensen, Asbjørn Hróbjartsson
Department of Orthopaedic Surgery Herlev University Hospital; Department
of Orthopaedic Surgery, Herlev University Hospital; Department of
Orthopaedic Surgery, Herlev University Hospital; Department of Orthopaedic
Surgery, Odense University Hospital; Department of Orthopaedic Surgery,
Aalborg University Hospital; The Nordic Cochrane Centre, Rigshospitalet
Background:
The indications for surgical intervention in complex fractures of
the proximal humerus are disputed. In elderly patients with poor bone stock it
may be impossible to obtain satisfactory fixation of the tuberosities to a
hemiarthroplasty (HA). In such cases primary insertion of a reverse shoulder
arthroplasty (RSA) has been suggested.
Purpose / Aim of Study:
To review clinical studies reporting benefits and
harms of RSA in acute fractures.
Materials and Methods:
A systematic review.
Findings / Results:
We included 18 studies containing 430 RSA in acute
fractures. We found no randomized clinical trials. Four studies compared
outcome after RSA with a historical control group of HA. The median
Constant Score was 58 (range 44-68) which is comparable to previous reviews
of HA in 4-part fractures. Complications included dislocation, infection,
hematoma, instability, neurological injury, reflex sympathetic dystrophy,
intraoperative fractures, periprosthetic fractures, and baseplate failure.
Scapular notching was reported in 11 studies with a median value of 25
percent (range 0 to 94). Heterogeneity of study designs and lack of primary
data precluded statistical pooling of data.
Conclusions:
No high quality evidence was identified. Based on the available
evidence the use of RSA in acute fractures is questionable. The complication
rate is high and the clinical implications of long term scapular notching are
worrying. Randomized studies with long term follow up using the latest
techniques of tubercular reinsertion in RSA towards HA should be encouraged.
