Figure. Anteroposterior radiograph of right shoulder.
A 75-year-old woman presents to the emergency department with severe right shoulder pain after a fall earlier in the day. Anteroposterior radiograph of the right shoulder shows a comminuted fracture of the proximal humerus (Figure). The patient reports that she is right-hand dominant and would like to continue to enjoy an active lifestyle with full use of her right arm and shoulder.
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Proximal humerus fractures are a common type of fracture seen in the emergency department and most can be treated nonoperatively. Complex comminuted fractures of the proximal humerus are much less common; the incidence, however, increases with advanced age, female gender, and presence of osteoporotic bone.1,2
In elderly patients, proximal humerus fractures are the third most common type of fracture behind hip and distal radius fractures.1,2 Poor bone quality makes fixing displaced and comminuted fractures more difficult. Complex fractures are prone to non-union and osteonecrosis after operative fixation.1,2
Reverse shoulder arthroplasty is an increasingly popular technique for the management of proximal humerus fractures that are deemed irreparable and have a high likelihood of osteonecrosis. The most common indication for a reverse total shoulder arthroplasty is a displaced 4-part proximal humerus fracture in a patient older than 70 years. A reverse total shoulder allows for rapid recovery without relying on fracture healing.1,2
Pain relief and shoulder function are sustained over time after recovering from reverse shoulder arthroplasty. Reverse total shoulder arthroplasty is associated with fewer complications and better shoulder function compared with shoulder hemiarthroplasty for displaced proximal humerus fractures.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
1. Jobin CM, Galdi B, Anakwenze OA, Ahmad CS, Levine WN. Reverse shoulder arthroplasty for the management of proximal humerus fractures. J Am Acad Orthop Surg. 2015;23(3):190-201. doi:10.5435/JAAOS-D-13-00190
2. Gallinet D, Cazeneuve JF, Boyer E, et al. Reverse shoulder arthroplasty for recent proximal humerus fractures: outcomes in 422 cases. Orthop Traumatol Surg Res. 2019;105(5):805-811. doi:10.1016/j.otsr.2019.03.019