ArticleArchives of orthopaedic and trauma surgery2022
Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly.
Article in Archives of orthopaedic and trauma surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 7 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 8 citations in OpenAlex.
- Comparative analysis of the improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty compared to open reduction and internal fixation: a systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2026Pooled it
- Reverse arthroplasty compared to hemiarthroplasty and open reduction and internal fixation for displaced proximal humerus fracture in patients above 60: a Bayesian network meta-analysis.Archives of orthopaedic and trauma surgery · 2025Pooled it
- Outcomes of reverse total shoulder arthroplasty vs. other surgical fixation methods for proximal humerus fractures in elderly patients.JSES reviews, reports, and techniques · 2026Review
- Complications following reverse total shoulder arthroplasty for proximal humeral fractures: a systematic review.JSES reviews, reports, and techniques · 2025Review
- Factors that affect external rotation following reverse shoulder arthroplasty: a retrospective multi-centre study on 501 shoulders.Archives of orthopaedic and trauma surgery · 2023Article
- Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2022Observational
- Effect of Pore Size of Porous-Structured Titanium Implants on Tendon Ingrowth.Applied bionics and biomechanics · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSurgical treatment of complex humeral head fractures in the elderly is challenging due to osteoporotic bone, comorbidities and reduced compliance. The treatment strategy (reconstruction versus replacement) should allow for a functional aftercare and result in a high patient satisfaction. Major complications leading to surgical revision are crucial and should be avoided. The purpose of this study was to analyse the major complication rate leading to surgical revision and the patient-based outcome in complex humeral head fractures of the elderly population treated either using locking plate fixation (LCP) or reversed total shoulder arthroplasty (rTSA). MATERIALS AND
methodsAll patients older than 65 years surgically treated due to a four-part fracture of the proximal humerus between 2003 and 2015 were enrolled in our retrospective study. Major complications and revision rates were recorded and functional outcome was assessed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score.
resultsA cohort of 103 patients with a mean age of 73.4 ± 6.2 years suffering from four-part fractures of the humeral head were enrolled. 63 patients were treated using the LCP fixation compared to 40 rTSAs. There were no significant differences in the patient-reported functional outcome. The revision rate was significantly higher in the LCP group (10/63; 15.9%) compared to the rTSA group (1/40; 2.5%). Reasons for revision were avascular head necrosis, cut-out of screws, secondary dislocation of the greater tuberosity and hypersensitivity to metal.
conclusionsReversed total shoulder arthroplasty and locking plate fixation are both established surgical procedures for the management of complex proximal humerus fractures in the elderly leading to similar functional results. However the revision rate in the rTSA group was significantly lower. Primary rTSA should, therefore, be favoured in multimorbid elderly patients with an increased complication risk to avoid repeated anaesthesia.
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