2018 年 4 巻 4 号 p. 103-107
Objectives: Operative therapy for proximal humerus fractures in older patients has improved recently, but the optimal surgical procedure is still controversial in those with osteoporosis. Generally, hemiarthroplasty (HA) is indicated in older patients with osteoporosis with three part, group-6 fractures or worse, according to the Neer classification system. To recover a good range of motion (ROM), bone fragments of the greater tubercle and lesser tubercle must be united with a humeral implant. Occasionally, these fragments are displaced during follow-up. However, even when their position unchanged, osteolytic changes can occur. We treated two patients with reverse shoulder arthroplasty (RSA) who both exhibited good functional results postoperatively.
Methods: Two patients (mean age: 82 years) who sustained proximal humerus fractures were clinically and radiographically evaluated. Fracture types included three-part, group-6, and four-part, group-6 fractures according to the Neer classification. The mean follow-up period was 17 months. After the two patients were treated with RSA, their shoulder ROM was evaluated until the final follow-up.
Results: Osteolytic changes in the greater tubercle were observed during the course of treatment in both patients. The mean active shoulder ROM for elevation, abduction, external rotation, and internal rotation was 120°, 110°, 25°, and to L5, respectively.
Conclusions: We obtained good functional results with RSA in two older patients with proximal humerus fractures and thus believe that RSA can be an appropriate treatment for complicated proximal humerus fractures in older adults.
