Proximal humeral fractures in the elderly : Quality of life, clinical results and institutionalization following primary reverse fracture arthroplasty

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Treatment of humeral head fractures in the elderly remains a challenge. Within the framework of demographic change the incidence as well as the direct and indirect consequences of injuries will rise. The analysis of an optimal treatment should include functional parameters as well as global health parameters, e.g. quality of life. The aim of this study was the evaluation of functional outcome, institutionalization (necessity of placement in a residential care home for the elderly, even if temporary), the influence of cognitive deficits, quality of life and the pattern of complications after primary reverse shoulder arthroplasty. The study included a total of 34 patients (mean age 79.8 ± 6.7 years, 29 female) after implantation of a reversed modular fracture arthroplasty. The mean follow-up was 23 ± 10.6 months). The functional Constant-Murley score (CS), radiology results as well as the extent of institutionalization and quality of life as measured by the EQ-5D questionnaire were collated. The clinical examination showed good results in the CS (54 points, SD ± 9). In comparison to the age and gender-related CS according to Gerber the patient scores amounted to 78.9 %. The comparison of patients with and without cognitive deficits did not show any differences (53 vs. 54 points, p = 0.6525). The rate of institutionalization after treatment of humeral head fractures by reversed fracture arthroplasty was 2.94 %. The quality of life measured with EQ-5D showed a health-related quality of life (HRQoL) of 0.801. The rate of complications was 2.94 % involving an incomplete lesion of the radial nerve which was in regression. The results of this study showed good to moderate functional results, very low rates of complications and institutionalization and very good results according to the HRQoL. In comparison to conservative treatment or plate osteosynthesis, better results were achieved in this study with respect to HRQoL.