Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery Vol. 29; no. 7; pp. S32 - S40
• Main Authors: Yahuaca, B. Israel, Simon, Peter, Christmas, Kaitlyn N., Patel, Shaan, Gorman, R. Allen, Mighell, Mark A., Frankle, Mark A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2020
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder - methods; Female; Fracture Fixation, Internal; Fracture Healing; fragility fracture; Hemiarthroplasty; Humans; Male; Middle Aged; Open Fracture Reduction; ORIF; Postoperative Period; proximal humeral fracture; Proximal humerus fracture; Range of Motion, Articular; Reoperation; reverse shoulder arthroplasty; Shoulder Fractures - classification; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - physiopathology; Shoulder Fractures - surgery; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Treatment Outcome; Young Adult; Treatment Study; reverse shoulder arthroplasty; proximal humeral fracture; ORIF; Proximal humerus fracture; fragility fracture; Retrospective Cohort Comparison; hemiarthroplasty; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.10.012

Proximal humerus fracture treatment varies by surgeon preference and patient factors. This study compares patient and fracture characteristics, with outcomes between current surgical treatment options. Between 1999 and 2018, 425 proximal humerus fractures underwent acute surgical management: open reduction internal fixation (ORIF, n = 211), hemiarthroplasty (HA, n = 108), or reverse shoulder arthroplasty (RSA, n = 106). Patient and fracture characteristics included age, American Society of Anesthesiologists physical status classification (ASA), and fracture classification. Postoperative motion at 3, 6, and minimum 12 months (avg 20 ± 21 months), radiographic outcomes, and postoperative falls were analyzed. Average age for treatment groups was 65 ± 13 years (range: 18-93 years). Fractures were classified as 2- (11%), 3- (41%), or 4-part (48%). Age, ASA, and fracture classification were associated with selected surgical management (P < .0001, =.001, <.0001, respectively). Outcomes showed a significant improvement in forward flexion from 3 months to 6 months in all groups (P < .0001). No difference in final motion was seen between groups. Radiographic union was higher in ORIF (89%), and similar between HA (79%) and RSA (77%, P = .005). Rate of reoperation was RSA 6.6%, ORIF 17.5%, and hemiarthroplasty 15.7% (P = .029). Postoperatively, 23% patients had at least 1 fall, of which 73% resulted in fractures. Older patients with high ASA were treated with arthroplasty, and younger patients with lower ASA were treated with ORIF. All groups showed improvements in motion. At minimum 1 year of follow-up, there was no difference in motion between groups. ORIF and HA showed significantly more reoperations compared with RSA. Patients should be counseled about reoperation, fall risk, and prevention.