Reverse for fracture: indications, techniques, and outcomes
The introduction of the reverse shoulder arthroplasty (RSA) has improved the surgical armamentarium in the treatment of complex proximal humerus fractures in the elderly. Surgical treatment for this patient population has historically seen poor and unpredictable function and outcomes provided by open reduction and internal fixation and hemiarthroplasty (HHR). Negative factors in these patients include osteopenic bone and osteoporosis, which can lead to loss of fixation, screw penetrance, nonunion, tuberosity resorption, poor function, pseudoparalysis and need for secondary operations in both internal fixation and HHR. Reported results and comparative studies have shown support in the use RSA for the treatment of complex proximal humerus fractures in the elderly due to improved predictable functional outcomes and pain relief. These results seem to be reached more easily and with a less dedicated postop rehabilitative program than internal fixation or HHR. Repair and healing of the tuberosities may be more predictable and obtainable with RSA, which leads to improved external rotation, forward elevation, clinical outcomes and patient satisfactions. There is a significant learning curve in the use of this prosthesis; surgeons should use appropriate judgment and have a certain acquaintance with the utilization of the RSA in this setting. Midterm results have been promising in regards to clinical outcomes and longevity; good results can be obtained with careful preoperative planning and attention to detail in utilizing this technique in this ever-growing patient population.