Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY; and.
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
J Orthop Trauma. 2023 Jun 1;37(6):e247-e252. doi: 10.1097/BOT.0000000000002559.
To evaluate early outcomes (within 1 year) for geriatric proximal humerus fractures managed nonoperatively or with reverse shoulder arthroplasty (RSA).
Retrospective cohort.
Academic level 1 trauma center, level 2 trauma/geriatric fracture center.
PATIENTS/INTERVENTION: Seventy-one patients with proximal humerus fractures that underwent nonoperative management or RSA, matched by age, comorbidity burden, and fracture morphology.
Patient-reported outcomes, range of motion, and complications rates within 1 year of treatment.
RSA patients demonstrated greater active forward flexion (aFF) and external rotation compared with nonoperative patients throughout the first 6 months after treatment ( P < 0.05 for all). RSA patients achieved satisfactory ROM (>90 degrees aFF) at higher rates than nonoperative patients (96.2% vs. 62.2%, P < 0.01). RSA led to significantly lower shoulder pain and PROMIS pain interference scores throughout the first year post-treatment ( P < 0.05). PROMIS physical function scores were also higher in the RSA group at 3 months, 6 months, and 1 year compared with the nonoperative group ( P < 0.05 for all). Similar complication rates were experienced in both groups (nonoperative = 8.9%, RSA = 7.7%; P = 0.36).
In an age, comorbidity and fracture morphology matched analysis, treatment of proximal humerus fractures with RSA is associated with greater shoulder ROM throughout the first 6 months of treatment, decreased pain, and improved physical function compared with nonoperative management, without significant differences in short-term complications. These results suggest that RSA may be superior to nonoperative management during the early recovery period for proximal humerus fractures.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估老年肱骨近端骨折经非手术或反肩关节置换术（RSA）治疗的早期结果（1 年内）。
回顾性队列研究。
学术 1 级创伤中心，2 级创伤/老年骨折中心。
患者/干预措施：71 例肱骨近端骨折患者，行非手术治疗或 RSA 治疗，按年龄、合并症负担和骨折形态匹配。
治疗后 1 年内患者报告的结果、活动范围和并发症发生率。
与非手术组相比，RSA 组患者在治疗后前 6 个月的主动前屈（aFF）和外旋角度更大（所有 P < 0.05）。RSA 组患者达到满意的 ROM（>90°aFF）的比例高于非手术组（96.2%比 62.2%，P < 0.01）。RSA 在治疗后 1 年内显著降低了肩部疼痛和 PROMIS 疼痛干扰评分（所有 P < 0.05）。与非手术组相比，RSA 组在治疗后 3 个月、6 个月和 1 年的 PROMIS 躯体功能评分也更高（所有 P < 0.05）。两组的并发症发生率相似（非手术组 8.9%，RSA 组 7.7%；P = 0.36）。
在年龄、合并症和骨折形态匹配分析中，与非手术治疗相比，RSA 治疗肱骨近端骨折在治疗的前 6 个月内与更大的肩部 ROM、减轻疼痛和改善躯体功能相关，且短期并发症无显著差异。这些结果表明，在肱骨近端骨折的早期恢复期间，RSA 可能优于非手术治疗。
治疗性 III 级。欲了解完整的证据等级说明，请参见作者须知。
