Prospective review of 43 elderly patients (mean age 78) treated with a Delta reverse shoulder prosthesis for displaced three- and four-part proximal humerus fractures. It asks whether the reverse design can deliver useful function in a population where tuberosity healing after hemiarthroplasty is unreliable.
The clinical decision rule: in an elderly patient with a displaced three- or four-part proximal humerus fracture and a poor-quality or cuff-deficient shoulder, reverse arthroplasty delivers deltoid-powered elevation that does not depend on tuberosity healing.
That matters because tuberosity malposition is the main reason hemiarthroplasty fails. Here, 53% of tuberosities displaced yet function held up, which is the whole biomechanical argument for the reverse design in this setting.
Expect trade-offs. External rotation stays weak when the greater tuberosity fails, and scapular notching (25%) and heterotopic ossification (90%) are common though usually low-consequence in low-demand patients. Read this as early evidence, not a mandate. The authors explicitly refuse to call it routine at 22-month follow-up, and glenoid loosening risk over time remains the unanswered question.
Prospective review of 43 elderly patients (mean age 78) treated with a Delta reverse shoulder prosthesis for displaced three- and four-part proximal humerus fractures. It asks whether the reverse design can deliver useful function in a population where tuberosity healing after hemiarthroplasty is unreliable.
The clinical decision rule: in an elderly patient with a displaced three- or four-part proximal humerus fracture and a poor-quality or cuff-deficient shoulder, reverse arthroplasty delivers deltoid-powered elevation that does not depend on tuberosity healing.
That matters because tuberosity malposition is the main reason hemiarthroplasty fails. Here, 53% of tuberosities displaced yet function held up, which is the whole biomechanical argument for the reverse design in this setting.
Expect trade-offs. External rotation stays weak when the greater tuberosity fails, and scapular notching (25%) and heterotopic ossification (90%) are common though usually low-consequence in low-demand patients. Read this as early evidence, not a mandate. The authors explicitly refuse to call it routine at 22-month follow-up, and glenoid loosening risk over time remains the unanswered question.