• Dtsch Arztebl Int · Dec 2021

    The Surgical Treatment of Proximal Humeral Fractures in Elderly Patients.

    • Josef Stolberg-Stolberg, Jeanette Köppe, Robert Rischen, Moritz Freistühler, Andreas Faldum, J Christoph Katthagen, and Michael J Raschke.
    • Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster; Institute of Biometrics and Clinical Research, University Hospital Münster; Department of Radiology, University Hospital Münster; Medical Management, Medical Controlling, University Hospital Münster.
    • Dtsch Arztebl Int. 2021 Dec 3; 118 (48): 817-823.

    BackgroundThe goal of this study is to compare mortality, major adverse events, and complication rates after the surgical treatment of proximal humeral fractures with locked plate fixation (LPF) versus reverse total shoulder arthroplasty (RTSA) in elderly patients.MethodsHealth insurance data from patients aged 65 and above for the period January 2010 to September 2018 were retrospectively evaluated. The median follow-up duration after LPF (40 419 patients) or RTSA (13 552 patients) was 52 months. Hazard ratios adapted to the patients' risk profiles were determined with the aid of multivariable Cox regression models. The p-values were adjusted using the Bonferroni-Holm method.ResultsAfter adaptation to the patients' risk profiles, reverse shoulder replacement showed statistically significantly lower mortality (HR 0.92, 95% confidence interval [0.88; 0.95]; p <0.001) and fewer major adverse events (HR 0.92 [0.89; 0.95]; p<0.001). Eight years after surgery, the risk of surgical complications was twice as high for LPF (12.2% [11.9; 12.7]; HR for RTSA versus LPF 0.5 [0.46; 0.55]; p<0.001 for both), with 3.8% [3.6; 4.0] of the patients receiving a secondary RTSA. Surgical complications were more common (p<0.05) in patients with a diagnosis of osteo - porosis, obesity, alcohol abuse, chronic polyarthritis, or frozen shoulder.ConclusionThe long-term findings are in agreement with clinical short-term findings from other studies and support the current trend toward more liberal use of reverse shoulder replacements in elderly patients.

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