Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults.

Autor: Roberson TA; Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA., Granade CM; School of Medicine, University of South Carolina, Greenville, SC, USA., Hunt Q; School of Medicine, University of South Carolina, Greenville, SC, USA., Griscom JT; School of Medicine, University of South Carolina, Greenville, SC, USA., Adams KJ; Hawkins Foundation, Greenville, SC, USA., Momaya AM; Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA., Kwapisz A; Hawkins Foundation, Greenville, SC, USA., Kissenberth MJ; Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA., Tolan SJ; Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA., Hawkins RJ; Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA., Tokish JM; Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA. Electronic address: Jtokish@ghs.org.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2017 Jun; Vol. 26 (6), pp. 1017-1022. Date of Electronic Publication: 2017 Jan 27.
DOI: 10.1016/j.jse.2016.10.013
Abstrakt: Background: The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups.
Methods: A retrospective review was performed on all 3- and 4-part proximal humeral fractures treated with either RSA or nonoperative treatment with minimum 1-year follow-up. All patients in the nonoperative cohort were offered RSA but declined. Objective patient data were obtained from medical records. Patient-reported outcomes including visual analog scale score, Single Assessment Numeric Evaluation score, Penn Shoulder Score, American Shoulder and Elbow Surgeons score, resiliency score, and Veterans Rand-12 scores were obtained at follow-up. Statistical analysis was performed by use of the Student t test for continuous variables and χ 2 analysis for nonparametric data.
Results: We analyzed 19 nonoperative and 20 RSA patients with a mean follow-up period greater than 2 years (29 months in nonoperative group and 53 months in RSA group). There were no differences in range of motion between groups (forward elevation, 120° vs 119° [P = .87]; external rotation, 23° vs 31° [P = .06]). No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes. Among patients receiving RSA, there was no difference in outcomes in those undergoing surgery less than 30 days after injury versus those receiving delayed RSA.
Conclusions: This study suggests that there are minimal benefits of RSA over nonoperative treatment for 3- and 4-part proximal humeral fractures in older adults.
(Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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