Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial

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dc.contributor.authorLópiz Morales, María Yaiza
dc.contributor.authorAlcobía Díaz, Borja
dc.contributor.authorGalán Olleros, María
dc.contributor.authorGarcía Fernández, Carlos
dc.contributor.authorLopez Picado, Amanda
dc.contributor.authorMarco Martínez, Fernando
dc.date.accessioned2024-08-07T08:31:30Z
dc.date.available2024-08-07T08:31:30Z
dc.date.issued2019-09-06
dc.description.abstractBackground: Proximal humeral fractures (PHFs) are among the most common fractures in elderly patients, but there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for their management. To date, no RCT has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for 3- or 4-part PHFs in elderly patients. Methods: This was a prospective RCT. The primary objective was to compare pain and function 12 months after fracture using the Constant score in patients aged 80 years or older with 3- and 4-part PHFs, treated by either RSA or nonoperative treatment. Secondary outcome measures included Disabilities of the Arm, Shoulder and Hand, visual analog scale (VAS), Short Form 12 (SF-12), EuroQol 5 Dimensions, and EQ-VAS scores. Results: We analyzed 30 nonoperative and 29 RSA patients with mean ages of 85 years and 82 years, respectively. No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes at 12 months' follow-up except the VAS pain score. The Constant scores were 55.7 in the nonoperative group and 61.7 in the RSA group (P = .071); the Disabilities of the Arm, Shoulder and Hand scores were 29 and 21, respectively (P = .075); the VAS scores were 1.6 and 0.9, respectively (P = .011); the physical SF-12 scores were 36 and 37, respectively (P = .709); the mental SF-12 scores were 43 and 42, respectively (P = .625); the EuroQol 5 Dimensions scores were 0.89 and 0.92, respectively (P = .319); and the EQ-VAS scores were 65 and 67, respectively (P = .604). Conclusions: This study yields important evidence for the treatment of complex PHFs in elderly patients suggesting minimal benefits of RSA over nonoperative treatment for displaced 3- and 4-part PHFs. At short-term follow-up, the main advantage of RSA appeared to be less pain perception.
dc.description.departmentDepto. de Cirugía
dc.description.facultyFac. de Medicina
dc.description.refereedTRUE
dc.description.sponsorshipFundación Mutua Madrileña
dc.description.statuspub
dc.identifier.citationLopiz Y, Alcobía-Díaz B, Galán-Olleros M, García-Fernández C, Picado AL, Marco F. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2019 Dec;28(12):2259-2271. doi: 10.1016/j.jse.2019.06.024. Epub 2019 Sep 6. PMID: 31500986.
dc.identifier.doi10.1016/j.jse.2019.06.024
dc.identifier.essn1058-2746
dc.identifier.issn1532-6500
dc.identifier.officialurlhttps://doi.org/10.1016/J.JSE.2019.06.024
dc.identifier.relatedurlhttps://www.sciencedirect.com/science/article/pii/S1058274619304653
dc.identifier.urihttps://hdl.handle.net/20.500.14352/107417
dc.issue.number12
dc.journal.titleJournal of Shoulder and Elbow Surgery
dc.language.isoeng
dc.page.final2271
dc.page.initial2259
dc.publisherElsevier
dc.rights.accessRightsrestricted access
dc.subject.cdu617.57
dc.subject.keywordProximal humeral fracture
dc.subject.keywordConservative treatment
dc.subject.keywordElderly
dc.subject.keywordPatient-reported outcome measures;
dc.subject.keywordQuality of life
dc.subject.keywordReverse shoulder arthroplasty
dc.subject.ucmSistema musculoesquelético
dc.subject.unesco3213.15 Traumatología
dc.titleReverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial
dc.typejournal article
dc.type.hasVersionVoR
dc.volume.number28
dspace.entity.typePublication
relation.isAuthorOfPublicationac13f2b2-91f6-40be-8d94-1b716483e3b1
relation.isAuthorOfPublicatione160ced6-aec8-4bde-9f5f-5d5872dadf87
relation.isAuthorOfPublication.latestForDiscoveryac13f2b2-91f6-40be-8d94-1b716483e3b1
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