Abstract
Background
Proximal humeral fractures in the elderly population represent a particularly demanding subset of fractures. These have been traditionally treated with Hemi-arthroplasty (HA). Recently there has been a trend towards using a Reverse shoulder replacement (RSR) in some of these patients. The primary aim of the study was to systematically review the literature on the functional outcome scores for RSR in proximal humeral fractures and compare it with the best quality literature available for HA. Secondarily to compare range of movement, complication rates, re-operation rates and x-ray changes.
Methods
A systematic review of the literature was performed using the keywords: Delta, inverse, shoulder, trauma, and fracture. Only studies with 10 patients or more, presenting new data on the functional outcome scores of RSR for acute trauma were included. Studies reporting the use of RSR for fracture sequalae were excluded. These results were compared to the most comprehensive and up to date literature available for HA for proximal humeral fractures.
Results
Eight papers met the full inclusion and exclusion criteria. Data was available for 178 patients with a minimum follow-up of only 3 months. The mean absolute constant score for RSR patients was 54% and 57% for HA patients. RSR had an infection rate of 3%, a dislocation rate of 4% and an overall re-operation rate of 5.6%.
Conclusion
Functional outcomes and range of movements achieved by RSR seem to be similar to those achieved by HA and may eventually be proven to have better outcomes in a certain sub-group of patients. However, there is currently less than 200 patients reported in the literature with a very short term follow-up. RSR is more expensive than HA, and there is a definite learning curve associated with this prosthesis. Although RSR may be valuable in patients where a traditional HA is deemed not suitable, caution must be used until better quality research is available.
Level of evidence: Level III systematic review of Level III studies
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