Salvage reverse shoulder arthroplasty after failed plate fixation of proximal humeral fractures: Clinical outcomes, complications, and prognostic factors

Background

Failed plate fixation (open reduction and internal fixation) for proximal humeral fractures causes bone loss, tuberosity malunion, and soft-tissue imbalance. Reverse shoulder arthroplasty (RSA) is a salvage option with variable outcomes. This study evaluated RSA outcomes for fracture sequelae and previous plate fixation and identified prognostic factors.

Methods

This retrospective monocentric study included patients undergoing RSA between 2011 and 2023 for fracture sequelae following plate fixation, with a minimum two-year follow-up. Outcomes included clinical scores, range of motion, patient satisfaction, and radiographic findings. Prognostic factors were analyzed using univariate analysis.

Results

Twenty-nine patients were included (mean follow-up 4.6 years; mean age 59 years). Clinical scores and range of motion improved compared with the preoperative evaluation (all p  < 0.05), except for external rotation. Final mean adjusted Constant score was 64%, Subjective Shoulder Value 56, and American Shoulder and Elbow Surgeons (ASES) 65. Overall, 34% had complications, 10% required reoperation, and 7% underwent revision.

The most common complication was persistent painful shoulder stiffness (21%). Humeral bone resorption in the previous plate area was observed in 50%. Greater tuberosity deficiency and anterior deltoid dysfunction were associated with worse outcomes.

Conclusion

RSA improves outcomes after failed plate fixation; however, recovery remains moderate, and complication rates are high. Tuberosity deficiency and anterior deltoid dysfunction are prognostic factors, and humeral bone resorption may affect long-term survival.

Level of evidence

Level IV; Case Series; Treatment Study.