Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review

Background: Proximal humerus fractures are one of the most common fractures among elderly patients. We performed a systematic review to detail the demographics, outcomes, and complications of patients who undergo reverse shoulder arthroplasty for complex proximal humerus fractures. Methods: A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodical quality of each study. Studies that met our criteria were assessed for pertinent data, and when available, similar outcomes were combined to generate frequency-weighted means. Results: Nine studies met the inclusion and exclusion criteria for this review. The frequency weighted mean age was 77.5 years and the mean follow up was 43.2 months. Females comprised 90.4% of the patient population. Four-part fractures were most commonly encountered. The frequency weighted mean constant's score was 55.9. Frequency weighted mean active forward flexion, abduction, and external rotation at neutral were 122 degrees, 97 degrees, and 18 degrees, respectively. Tuberosity repair was associated with significantly higher external rotation compared to no repair (24 degrees vs 15 degrees; P=.0003). The most common complication was scapular notching (32%) while the impact of this finding remains unknown. Conclusion: Pooled data and frequency weighted mean outcomes showed that RSA patients tend to be elderly women and still have postoperative dysfunction despite well-controlled pain. Repair of the greater tuberosity allows greater range of motion in patients. Level of evidence: Level IV, Systematic Review. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.