Outcomes of Reverse Shoulder Arthroplasty in the Management of Proximal Humerus Fractures Following Failed Internal Fixation

Aim: This research aims to assess the clinical and functional outcomes of reverse shoulder arthroplasty (RSA) in patients with proximal humerus fractures who underwent revision surgery following unsuccessful internal fixation. The influence of fracture classification and the timing of revision surgery on postoperative pain, range of motion (ROM), and functional outcomes was also evaluated. Material and Method: A retrospective analysis was performed on patients aged 65 years or older who sustained fractures due to low-energy trauma, such as simple falls, and underwent RSA due to failed internal fixation of proximal humerus fractures between 2017 and 2020. Patients with intraoperatively identified irreparable rotator cuff tears were included in the study.Functional outcomes were measured using the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, the Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH), and Visual Analog Scale (VAS). Additionally, ROM, including flexion, abduction, internal rotation, and external rotation, was assessed. Statistical comparisons were conducted based on fracture classification (Neer Type 3 vs. Neer Type 4) and the interval between the initial fixation and revision surgery. Results: Patients with Neer Type 4 fractures had poorer functional outcomes and higher pain levels than those with Neer Type 3 fractures. The VAS score was higher (3.2±1.8 vs. 0.9±0.9), and the Constant-Murley score was lower (50.7±10.4 vs. 61.8±9.0) in Neer Type 4 patients. Delayed revision surgery led to greater functional decline, increased pain, and restricted motion. Flexion (102.9±23.1°) and abduction (99.4±19.2°) were better preserved in Neer Type 3 fractures than in Neer Type 4 (80.0±22.8° and 73.3±22.5°). However, RSA effectively reduced postoperative pain (VAS 1.5±1.5) and improved functional scores (ASES 59.0±21.3). Conclusion: RSA serves as a reliable reconstructive option for managing complications arising from unsuccessful surgical stabilization of proximal humerus fractures, especially in cases where the rotator cuff damage is beyond repair. Early revision surgery is linked to superior functional recovery, whereas delayed intervention may result in heightened pain and restricted shoulder movement.