Reverse shoulder arthroplasty without subscapularis repair for the treatment of proximal humeral fractures in the elderly.

PURPOSE: The aim of this study was to evaluate the short-term results after reverse shoulder arthroplasty (RSA) for proximal humeral fractures in elderly patients.

METHODS

The same surgical technique was adopted in all patients: the procedure was performed through a deltopectoral approach, the subscapularis was always resected, and a positioning jig was used to implant the cemented humeral component in the desired height and in 20° of retroversion. Nineteen consecutive patients, affected by complex fractures of the proximal humerus, were operated in a 3-year period by the same surgeon at a single institution. All the patients were female, with a mean age of 75 years (range 70-83).

RESULTS

Fifteen patients were evaluated at an average follow-up of 22 months (range 12-46 months). A postoperative infected hematoma was the only recorded complication. The absolute Constant score averaged 45.7 (range 19-69), while the relative and normalized scores averaged 65.1 (range 33-97) and 58.5 (range 24-91), respectively. The average Shoulder Pain and Disability Index (SPADI) score was 39 (range 6-89). X-rays showed healing of the greater tuberosity to the humeral diaphysis in nine shoulders.

CONCLUSIONS

RSA is an established treatment option for elderly patients with proximal humeral fractures, particularly when general and local conditions are predictive of failure with hemiarthroplasty. Even though clinical results were quite variable in this series of patients, the adoption of a standardized surgical technique allowed to minimize postoperative complications. Subscapularis repair does not seem a critical factor for preventing implant dislocation, but its influence on functional results needs further investigation.