Outcome of geriatric proximal humeral fractures: a comparison between reverse shoulder arthroplasty versus open reduction and internal fixation

OBJECTIVES: In view of the increased attention to reverse shoulder arthroplasty (rTSA) as a treatment for complex proximal humeral fractures in the elderly, the present study analyzes in-hospital complications and the postoperative management of rTSA versus open reduction and internal fixation (ORIF). METHODS: We retrospectively reviewed patients hospitalized from 2016 to 2018 for proximal humeral fractures (ICD-9 codes: S42.21), III- and IV-part, who underwent an ORIF with locking plates, rTSA or nonoperative treatment. In-hospital complications and postoperative management in both groups were included in the analysis. RESULTS: We included n 190 patients (ORIF 90, rTSA 71, nonoperative 29), more likely to be female (82.1% vs 17.9%; P < .01) with an average age of 82years (min. 72, max. 99; SD 6.4). The ORIF and the rTSA groups showed comparable complication rates (15.6% vs 15%, P = .87) but with a significantly shorter hospital stay (8.6 vs 11.5days; P = .01) and shorter duration of surgery (72.9 vs 87.2 minutes; P = .01) in the ORIF group. Significantly more patients after ORIF achieved an independent life postoperatively (53.3% vs 40.8%; P = .013). CONCLUSIONS: In this retrospective analysis, ORIF is related to a shorter duration of surgery, a shorter hospital stay and a higher likelihood of independence. Despite the popularity of the rTSA, ORIF remains a reliable treatment option for proximal humeral fractures in the elderly. Level of evidence: III