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.