• Simon W Young, Barak S Segal, Perry C Turner, and Peter C Poon.
• Department of Orthopaedic Surgery, North Shore Hospital, Takapuna Auckland, New Zealand. simonwyoung@gmail.com
• ANZ J Surg. 2010 Nov 1; 80 (11): 789-93.

BackgroundTreatment of complex proximal humeral fractures remains controversial. In cases where adequate open reduction and internal fixation cannot be achieved, hemiarthroplasty has been the traditional treatment; however, clinical results have been mixed. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, and this study aimed to compare the functional results of RSA versus hemiarthroplasty in patients with acute proximal humeral fracture.MethodsTen patients with acute proximal humerus fractures unsuitable for internal fixation (mean age 77) who underwent RSA for acute proximal humerus fracture unsuitable for internal fixation against the outcomes of 10 patients (mean age 75) who had previously undergone hemiarthroplasty for the same indication. Functional scores and radiographic outcomes were assessed at 22-44 months follow up.ResultsAt follow up the mean American Shoulder and Elbow Scorev score was 65 (range 40-88) in the RSA group and 67 (26-100) in the hemiarthroplasty group. Mean Oxford Shoulder scores were 29 (15-56) and 22 (12-34), respectively. Mean forward elevation was 115 degrees (range 45-140 degrees) and active external rotation was 49 degrees (5-105 degrees) in the RSA group, versus 108 degrees (50-180 degrees) and 48 degrees (10-90 degrees) in the hemiarthroplasty group. No statistically significant differences in outcome scores or range of motion were seen.ConclusionIn these early results, the anticipated functional gains of RSA over hemiarthroplasty were not realized, suggesting the use of RSA for treatment of proximal humeral fractures should remain guarded. Larger prospective trials are necessary to identify the optimal management of patients in this situation.© 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

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