The objective of our study was to compare patient-reported outcome measures, range of motion, complication rates, and reoperation rates following rTSA for proximal humerus fracture between patients treated acutely ( 30 days following injury), and those treated after failed ORIF. Secondarily, we aimed to identify any patient-, injury-, or surgery-related factors independently associated with our response variables.
Between January 2003 to August 2018 we identified 576 patients who sustained a proximal humerus fracture treated with primary or revision shoulder arthroplasty. The final cohort included 153 patients. Multivariable analysis was used to assess whether explanatory variables were associated with our response variables.
Initial nonoperative treatment compared to acute rTSA was associated with worse SSV (p=0.04), SPADI (p=0.03), and SPADI-disability subscale (p=0.03) scores. Only depression was independently associated with worse VAS-pain (p=0.04) scores. There was no significant difference in postoperative range of motion among the initial treatment groups. Older age was associated with decreased range of motion in all planes. Additionally, ipsilateral upper extremity injury was associated with decreased active abduction (p=0.03) and cemented humeral stem was associated with decreased passive abduction (p=0.03). Initial nonoperative treatment was associated with increased complications (OR 3.65, 95% CI 1.11-12.01) and male sex was associated with higher rates of reoperation (OR 3.53, 95% CI 1.31-9.51).
Patients who undergo initial periods of nonoperative management have worse functional outcomes and higher complication rates than those who undergo acute rTSA for proximal humerus fractures. Patient who undergo rTSA after failed ORIF have no difference in patient reported outcomes when compared to those who undergo acute rTSA. In addition, male patients are at higher risk of reoperation, while older patients are at risk for decreased range of motion. Patients with preoperative depression are at risk for increased pain at 2 years after surgery LEVEL OF EVIDENCE: Level III; Retrospective Cohort Comparison; Treatment Study.

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