Reverse shoulder arthroplasty in proximal humerus fractures: What is the optimal neck-shaft-angle?
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Authors
Cross, George W. V.
Karam, Edward
Matheron, George
Lebe, Moritz
Stringfellow, Thomas D.
Domos, Peter
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Issue Date
2025
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Article
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Abstract
Purpose Limited evidence exists for functional outcomes of neck-shaft-angle (NSA) in reverse shoulder arthroplasty (RSA) for proximal humerus fractures (PHFs). We evaluated the functional outcomes of 155° versus 145° NSA RSA, to determine superiority for acute PHFs. Method Retrospective analysis of 66-patients with displaced 3/4-part, head-split or fracture-dislocation PHFs, managed with acute RSA, within 4-weeks of injury at single trauma unit. 33-patients underwent 155° NSA RSA cemented stem; 33-patients 145° NSA RSA uncemented stem. All had same glenoid components with equivocal humeral stem retrotorsion and routine reconstructions of tuberosities. Primary outcome was range of motion; with radiological, and patient reported outcome measures (PROMs) as secondary outcomes. Results Median age 72 years. Median follow-up 27 months. Healed greater tuberosity (GT) conferred better outcomes for all. 155° NSA conferred better GT healing, although not significant (93% vs 78%; p = 0.18). 145° NSA achieved significantly better external rotation in adduction (ER1) of 51° vs 32° (p = 0.02) and internal rotation of 7.5 vs 5.4 points (p = 0.03), whilst 155° had greater percentage patients (83% vs 66%) reach functional active elevation (AE) (>130°). Despite an unhealed GT, 145° NSA was still associated with better ER1 (p = 0.04). OSS significantly better in 145°, 44 vs 39 (p = 0.03), with no significant difference across other PROMs. 145° reached minimal clinically important difference for OSS (5-points) and ER1 (5°), whilst conferring substantial clinical benefit for ER1 (11°). Low complication rate for both cohorts (6.06%). Conclusions Both groups provided reliable and satisfactory outcomes in acute management of PHFs. 155° NSA provides better AE and GT healing; 145° NSA achieving better rotational movements, extension and OSS. Level III evidence Retrospective Cohort Comparison; Treatment Study
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European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Volume
36
Issue
1