Reverse shoulder replacement compared with hemiarthroplasty for proximal humeral fractures

摘要

Charles Neer was the first to advocate the use of hemiarthroplasty as the treatment of choice for four-part proximal humeral fractures. Since this original description, many authors have used hemiarthroplasty for four-part fractures because of the risk of osteonecrosis of the humeral head. Careful examination of the results of hemiarthroplasty, however, have shown unreliable results, especially in patients over 70 years typically due to tuberosity malunion, nonunion, or resorption. Recently, the use of reverse shoulder arthroplasty has been introduced as an alternative solution for four-part fractures in the elderly. Using the reverse implant, functional recovery may be possible without anatomic tuberosity healing. Preliminary results have been encouraging, with several reports of predictable improvement of both pain relief and function. While hemiarthroplasty remains a reasonable treatment for four-part fractures, reverse shoulder arthroplasty should be considered a reliable option in patients over 70 years.