Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial

Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, yet there is insufficient evidence from randomized controlled trials (RCTs) to determine the most appropriate interventions for their management. This study presents the long-term results of the first prospective RCT comparing surgical treatment with reverse shoulder arthroplasty (RSA) versus nonoperative treatment in displaced PHFs in elderly patients. Patients from a previously published RCT of 62 patients, in which RSA was compared with nonoperative treatment, were followed up long term. All patients were aged 80 years or older with 3- or 4-part displaced PHFs. Functional (Constant, Disabilities of the Arm, Shoulder and Hand questionnaire, Short Form 12 [SF-12], and visual analog scale) and radiographic outcomes were assessed. From the initial series, 12 patients treated conservatively and 17 with RSA were included, with mean ages of 88 and 92 years (P = .004) and mean follow-up of 7.4 and 7.6 years (P = .171), respectively. Functional outcomes for RSA versus conservative treatment were as follows: Constant 62/51 (P = .039), Disabilities of the Arm, Shoulder and Hand questionnaire 16/25 (P = .069), SF-12 Physical 42/43 (P = .808), SF-12 Mental 59/60 (P = .690), and visual analog scale 1.5/1.4 (P = .274). All nonoperatively treated fractures healed in malposition, but none required revision to RSA. Among patients treated with RSA, one required revision surgery due to prosthesis dislocation. These results suggest that long term treatment with RSA for displaced 3- or 4- part PHF provides better functional outcomes compared to nonoperative treatment. This difference is attributed to the deterioration of functional outcomes of the nonoperative treatment over time.