Reverse total shoulder arthroplasty efficacy in proximal humeral fractures treatment: a systematic Review

Introduction: Currently there are many controversies in several aspects of surgical management of proximal humeral fractures, such as the optimal surgical approach and the role of reverse shoulder arthroplasty. For all these reasons, the main objective of the present study is to evaluate, through a systematic review of, the role of reverse total shoulder arthroplasty (RTSA) in proximal humeral fractures. Methods: Two reviewers independently searched through the Pubmed, Medline and Embase databases for studies published up to August 22, 2018. The following descriptors were used: "reverse total shoulder arthroplasty"; " total shoulder prostheses"; "fractures"; "fracture of the proximal humerus." Treatment”; “Efficacy”. The following filters were used to arrive at the expected final result: "Clinical Trial"; "Randomized Controlled Trial," "Randomized Clinical Trial," "Meta-Analysis," "Systematic Reviews." Results: There was a strong correlation between the two researchers' search results (k = 0.853). In this review, a total of 589 patients with proximal humeral fracture treated with RTSA were included. There were 60 men (10.8%) and 529 women (89.2%). The mean age was 75.5 ± 2.2 years. RTSA was associated with a number of clinical complications, such as infection (10.4%) as well as a lower revision rate (1.02%). Average patient satisfaction rate was 86% Conclusion: Through the literature, it is possible to report that for complex fractures of the proximal humerus, where reconstruction is not feasible, RTSA may be the most appropriate treatment option, especially in older patients requiring less of the joint. However, new studies with level of evidence I and II are fundamental to answer this question definitively.