Reverse shoulder arthroplasty versus non operative treatment of 3-part and 4-part proximal humerus fractures in the elderly patient: A pooled analysis and systematic review

Abstract text (incl. references and figure legends)

Background

The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options reverse shoulder arthroplasty (RSA) and non operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus non-operative treatment.

Methods

Studies comparing RSA and NOT were included for direct comparison by systematic review and pooled analysis for patient rated outcome and range of motion. Additionally, indirect comparison of case-series and non-comparative studies on either treatment modalities was performed separately.

Results

Three comparative studies were included with 77 patients that underwent RSA and 81 NOT. Both the Constant Murley score (mean difference 6 points) and DASH score (mean difference 8 points) were better in the RSA group. No differences were deteced in ASES, PENN score, pain scores and range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%) and dislocation (2%). Reoperation was required in 5%. In the NOT group common complications included malunion (42%), osteonecrosis (25%) and non-union (3%), however no reoperation was required. Patient satisfaction was equally high in both groups (RSA 100% RSA versus NOT 93%).

Conclusion:

Functional results appear to be slightly better for RSA. However, patient satisfaction seems comparable despite a high mal-union and osteonecrosis rate in the NOT group which, notably, do not require re-intervention. These results should however be viewed in light of distinct differences in patient characteristics between treatment groups.

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