Patients with delayed RSA after proximal humerus fracture may show higher reoperation risk
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Key takeaways:
- Delays longer than 28 days between proximal humerus fracture and RSA were associated with increased risks of reoperation.
- Surgeons should reconsider the “wait-and-see” approach when managing these patients.
SCOTTSDALE, Ariz. — Surgical delays of longer than 28 days were associated with increased odds of reoperation at 2-year follow-up for patients who underwent reverse shoulder arthroplasty for a proximal humerus fracture.
“The clinical outcomes of primary reverse [shoulder arthroplasty] following the trial of initial nonoperative management for these complex proximal humerus fractures (PHFs) still remains controversial,” Ujash Sheth, MD, MSc, FRCSC, said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting. “The current literature shows mixed results for the acute vs. delayed primary RSA for these fractures,” he added.
To determine the optimal time interval between PHF and RSA, Sheth and colleagues performed a population-based cohort study of 891 patients (mean age of 72.7 years) who underwent primary acute (n = 685) vs. delayed (n = 206) RSA for a PHF between April 1, 2004, and March 31, 2019. According to the abstract, outcomes included complications and reoperations. Patients who underwent either open reduction and internal fixation or hemiarthroplasty prior to RSA were excluded to remove salvage procedures.
Overall, mean time from PHF to RSA was 41.8 days among the cohort. Sheth and colleagues found significantly lower reoperation rates for the acute RSA group (3.9%) compared with the delayed RSA group (8.3%). Sheth also noted a delay of longer than 28 days between fracture and surgery was associated with increased odds of reoperation by 2 years (OR = 2.1). He noted odds of reoperation plateaued at 100 days after PHF.
Sheth said that prolonged immobilization and reduced shoulder mobility associated with delayed surgery could lead to joint stiffness and muscle atrophy, which could prolong rehabilitation efforts and lead to negative outcomes.
“Perhaps we should reconsider the ‘wait-and-see’ approach often taken when managing these elderly patients with acute, complex, three- [or] four-part PHFs,” Sheth concluded.
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Sheth U, et al. Paper 23. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 4-7, 2023; Scottsdale, Ariz.
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