Abstract：
BACKGROUND:Significant controversy surrounds optimal treatment of displaced 4-part proximal humeral fractures. Reverse total shoulder arthroplasty (RTSA) has recently been proposed as an alternative to hemiarthroplasty (HA) and open reduction-internal fixation (ORIF). Several authors have questioned the additional implant cost for RTSA. The purpose of this study was to compare outcomes and cost of RTSA, HA, and ORIF. MATERIALS AND METHODS:We prospectively evaluated patients who underwent RTSA for displaced 3- and 4-part proximal humeral fractures and then retrospectively developed age- and sex-matched control groups with 3- and 4-part proximal humeral fractures who underwent HA and ORIF. Range of motion including active forward elevation and external rotation and time to achieve active forward elevation >90° were recorded. American Shoulder and Elbow Surgeons (ASES), Short-Form 12-item (SF-12), and Simple Shoulder Test (SST) scores were recorded. In addition, treatment cost was assessed by Medicare data and implant list prices. RESULTS:This study enrolled 27 patients; 9 underwent RTSA, 9 HA, and 9 ORIF. Minimum follow-up was 1 year. No significant differences were seen in SST, ASES, or SF-12 scores. Significantly more patients achieved >90° of active forward elevation after RTSA (P = .012). RTSA provided significant cost savings to Medicare compared with HA and ORIF (P = .002.) CONCLUSION:In this case-control study, RTSA appears to provide superior range of motion earlier and more predictably than HA and ORIF, with significant cost savings to Medicare.
journal_name
J Shoulder Elbow Surgjournal_title
Journal of shoulder and elbow surgeryauthors
Chalmers PN,Slikker W 3rd,Mall NA,Gupta AK,Rahman Z,Enriquez D,Nicholson GPdoi
10.1016/j.jse.2013.07.044subject
Has Abstractpub_date
2014-02-01 00:00:00pages
197-204issue
2eissn
1058-2746issn
1532-6500pii
S1058-2746(13)00387-Xjournal_volume
23pub_type
杂志文章abstract：BACKGROUND:Despite an increasing prevalence of patients sustaining pathologic fractures of neoplastic origin, few studies have investigated 30-day postoperative complication profiles following surgical treatment of pathologic humerus fractures. The purposes of this study were to use a large nationally representative da...
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abstract：:The posterior border of the ulna is the most important bony landmark for all dorsal surgical approaches and the guideline for open reduction, internal fixation of displaced comminuted fractures of the proximal ulna. We examined 74 cadaveric specimens to evaluate the anatomy of the proximal ulna, especially the course ...
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doi：10.1016/j.jse.2011.11.025
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journal_title：Journal of shoulder and elbow surgery
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journal_title：Journal of shoulder and elbow surgery
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journal_title：Journal of shoulder and elbow surgery
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journal_title：Journal of shoulder and elbow surgery
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abstract：BACKGROUND:Proximal humerus fractures are one of the most common fractures among elderly patients. We performed a systematic review to detail the demographics, outcomes, and complications of patients who undergo reverse shoulder arthroplasty for complex proximal humerus fractures. METHODS:A systematic review of the li...
journal_title：Journal of shoulder and elbow surgery
pub_type： 杂志文章,评审
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journal_title：Journal of shoulder and elbow surgery
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journal_title：Journal of shoulder and elbow surgery
pub_type： 杂志文章,多中心研究
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journal_title：Journal of shoulder and elbow surgery
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abstract：:The purpose of this study is to report on our experience with thermal capsulorrhaphy in the treatment of multidirectional instability of the shoulder. Thirty-three consecutive patients (33 shoulders) with multidirectional instability were treated with arthroscopic thermal capsulorrhaphy. Twelve patients had a history ...
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