Superior Outcomes with Reverse Shoulder Arthroplasty Versus Nonoperative Management for Proximal Humerus Fractures: A Matched Cohort Analysis.

Abstract

To evaluate early outcomes (within 1 year) for geriatric proximal humerus fractures managed nonoperatively or with reverse shoulder arthroplasty (RSA). Retrospective cohort Setting: Academic level 1 trauma center, level 2 trauma/geriatric fracture centerPatients/Intervention: 71 patients with proximal humerus fractures that underwent nonoperative management or RSA, matched by age, comorbidity burden, and fracture morphology. Patient reported outcomes, range of motion, and complications rates within 1 year of treatment. RSA patients demonstrated greater active forward flexion (aFF) and external rotation compared to nonoperative patients throughout the first 6 months after treatment (p<0.05 for all). RSA patients achieved satisfactory ROM (>90° aFF) at higher rates than nonoperative patients (96.2% vs 62.2%, p<0.01). RSA led to significantly lower shoulder pain and PROMIS pain interference scores throughout the first year post-treatment (p<0.05). PROMIS physical function scores were also higher in the RSA group at 3 months, 6 months, and 1 year compared to the nonoperative group (p<0.05 for all). Similar complication rates were experienced in both groups (nonoperative=8.9%, RSA=7.7%; p=0.36). In an age, comorbidity and fracture morphology matched analysis, treatment of proximal humerus fractures with RSA is associated with greater shoulder ROM throughout the first 6 months of treatment, decreased pain, and improved physical function compared to nonoperative management, without significant differences in short term complications. These results suggest that RSA may be superior to nonoperative management during the early recovery period for proximal humerus fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.