Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis

J Orthop Trauma. 2008 Nov-Dec;22(10):698-704. Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA.

OBJECTIVES: To evaluate clinical and radiologic results after implantation of the Delta III reverse shoulder prosthesis in elderly patients with comminuted fractures of the proximal humerus. DESIGN: Prospective, single-center-based cohort study. SETTING: Level II Trauma Center. PATIENTS: Patients undergoing insertion of Delta III reverse shoulder prosthesis for the treatment of comminuted fractures of the proximal humerus between July 2002 and December 2004. INTERVENTION: Surgery with the Delta III reverse shoulder prosthesis through a juxta-acromial approach. MAIN OUTCOME MEASURES: Duration of surgery, x-ray evaluation by Nerot's Score, complications, and functional outcome based on the Constant Score, the modified American Shoulder and Elbow Surgeons Score, the Disabilities of the Arm, Shoulder and Hand Score, and the 36-item short-form health survey (SF-36) Score. RESULTS: Twenty patients (14 females, 6 males) with a mean age of 74.85 +/- 5.73 years were included into the study followed up for 33.29 +/- 9.6 months. The average range of motion was for abduction 112.5 +/- 38.19 degrees and for anterior elevation 122.67 +/- 32.84 degrees. The mean Constant Score was 67.85 +/- 13.56. The mean Disabilities of the Arm, Shoulder and Hand Score was 46.85 +/- 15.68, and the mean modified American Shoulder and Elbow Surgeons Score was 68 +/- 11.83. The Physical Component Scale of the SF-36 was 38 +/- 11.94. The Mental Component Scale of the SF-36 score was 52.59 +/- 10.92. Operations were performed 10.05 +/- 8.78 days (3-41) after trauma, and the average operation time was 75.7 +/- 18.11 minutes. CONCLUSIONS: The good functional outcome and the short intervention time in our present study and not needing a sufficient rotator cuff for implementation purposes suggest the use of the Delta III reverse shoulder prosthesis as a treatment option for elderly patients with comminuted fractures of the proximal humerus.