Surgical Techniques for the Treatment of Proximal Humerus Fractures in Elderly Patients: A Comparative Analysis

Abstract

Aims: It is common for the elderly, mostly due to osteoporosis and falls, to suffer proximal humerus fractures. This study aims to compare the efficacy of reverse total shoulder arthroplasty (rTSA) and open reduction with internal fixation (ORIF) in the treatment of these fractures with a focus on functional outcomes and patient satisfaction. Methods: In this retrospective study, 65-85-year-old patients who underwent rTSA or ORIF for displaced proximal humerus fractures between January 1, 2021 and January 1, 2022 were analysed. Sixty patients participated in this study; they were divided into two groups as follows: Group 1 (rTSA, n=30) and Group 2 (ORIF, n=30). Constant and Oxford shoulder scores were used to evaluate outcomes while complications and patient satisfaction were also recorded. Statistical analysis involved t-tests and Chi-square tests whereby the p-value <0.05 indicated significance. Results: There was considerable improvement in various categories: Group 1 (rTSA), the constant score improved from preoperative stage of 35 ±8 to postoperatively of 75±10; oxford score ranged from preoperative level of 25±6 to postoperative level of 80±9 respectively p<0.05 for both cases Group II (ORIF), the constant score improved from preoperative stage of33±7to postoperatively of65±12; oxford score ranged from preoperative level24±5to postoperative level70±11respectively(p<0.05 for both). Patients undergoing rTSA than those on ORIF, with corresponding rates being very satisfied at66.7% versus54.5%. Several complications occurred more frequently in the ORIF group including delayed union (18.2% vs3.3%) and infection (22.7 vs6.7%). Conclusions: rTSA is associated with better functional outcomes, higher patient satisfaction, and fewer complications compared to ORIF for proximal humerus fractures in the elderly. These findings suggest that rTSA may be a more favourable surgical option for this population of patients. Moreover, future studies should involve larger samples and look at longer follow-up periods to ascertain these results.