Comparison of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of the comminuted proximal humeral fractures of the elderly

Objective: In the treatment of the proximal humeral fractures of the elderly using hemiarthroplasty (HA), functional results sometimes becomes unsatisfactory due to tuberosity healing problems or rotatory cuff tear, which make reverse shoulder arthroplasty (RSA) popular in recent years. This study compares the results of HA and RSA in the treatment of comminuted proximal humeral fractures of the elderly. Patients and methods: We included patients who were over 60 years-old and referred to Bezmialem Vakıf University, between 2011 and 2015, for three or four parts, closed, traumatic proximal humeral fractures. Twenty-five patients were treated with HA and 33 patients with RSA. According to Neer classification, 11 patients were classified as type 3 and 14 patients as type 4 in the HA group. In the RSA group, seven patients were classified as type 3 and 26 patients as type 4. Preoperative and postoperative direct roentgenograms, and computed tomography, if necessary, were obtained. The patients were evaluated at their last follow-ups using American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores, active and passive ranges of motions of the shoulders and muscle strength measurements and the results of HA and RSA were compared. Results: The mean ages of the patients were 66 (range, 60 to 85) in HA group and 73 (range, 60 to 83) in RSA group (p=0,013). The mean ASES scores were 44,6 and 70 (p=0,06), Constant scores were 24 and 49 (p=0,022), DASH scores were 62,5 and 44 (p=0,126). The mean active abductions were measured as 50° and 90° (p=0,001), flexions as 70° and 120° (p=0,002), external rotations as 30° and 50° (p=0,210), respectively. Conclusions: According to the results of our study, in the treatment of three or four parts of proximal humeral fractures of the elderly, RSA gives significantly better functional results compared to HA. We hope that this study will provide an insight for the future studies with long term results of RSA in the proximal humeral fractures. Key words: Proximal humeral fractures, hemiarthroplasty, reverse shoulder arthroplasty