Die inverse Schulterendoprothese als alternative Versorgung der komplexen proximalen HumerusfrakturEine vergleichende Untersuchung der primären und sekundären Implantation einer inversen Schulterprothese

We examined 30 patients, who received a reverse shoulder arthroplasty (RSA) for trauma indication at the university hospital of Marburg between 01/2008 and 02/2011. The patients were divided into two groups: The first group (19 patients) received RSA immediately after trauma, the second group (11 patients) got RSA after failure of either osteosynthesis or conservative treatment. The aim of the study was to picture the clinical results and to compare both groups. The mean age was 76 years. The mean follow-up was 1,46 years. ASES-, Constant- and Oxford Shoulder Score were evaluated. In each parameter we found slightly better results in the group of primary implanted RSA. VAS pain score was 1,84 with primary implementation, versus 2,06 in the secondary group. Half of the primary operated patients had no pain (52,6%) and a third of the secondary operated ones (36,4%). Furthermore the ASES- and Constant score show better results for the primary group (ASES: 60,8 points vs. 57,4 points, Constant: 41,1 points vs. 33,9 points). Range of motion demonstrates the same tendency. Mean abduction of 80° and mean elevation of 83° is achieved by the primary operated group, versus 74° and 71° respectively in the secondary group. Altogether the difference compared with the unaffected arm is 60° to 70°. The Oxford Shoulder Score shows a slightly better result in the primary group (28,7 points vs. 31,4 points). Regarding the literature, comparable studies show similar or considerably better results after RSA for trauma indication. Especially measurement of strength as a part of the Constant score is handled differently. Therefore a direct comparison of different studies should be done with caution. The majority of all studies claim RSA a reliable option for complex proximal humeral fractures in the elderly with osteoporotic bone conditions. A significant pain reduction is achieved with a sufficient functional outcome. Overall it is a reliable procedure with pain relief and predictable improvements in range of motion (ROM). Rotation remains limited, but there have been new promising procedures developed to improve especially external rotation. Currently there is a trend towards refixation of the tubercles. Complication rates are noted 20- 30%. Due to the possible decline of functional outcome in the long-term outcome and the missing escape procedures indication for RSA should be limited to patients older than 65 years. The challenge in treatment of proximal humeral fractures is to find the right treatment for the individual patient. RSA is a reliable option for complex proximal humeral fractures and failure of other treatments.