Long-Term Outcomes of RSA vs Nonoperative Care for Proximal Humerus Fractures .
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Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial.
J Shoulder Elbow Surg . 2025 Jun;34(6):1463-1470.Twenty-nine elderly patients (≥80 years) with displaced 3- or 4-part proximal humerus fractures were randomized to receive reverse shoulder arthroplasty (RSA) (n=17) or nonoperative treatment (n=12). The primary outcome was the Constant score. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion (ROM), pain (VAS), SF-12, EQ-5D, and radiographic findings. Outcomes were assessed at a mean follow-up of approximately 7.5 years. Overall, the results revealed that RSA achieved significantly higher Constant scores and better ROM, with no significant differences in quality-of-life measures or pain. Radiographically, all nonoperative cases healed in malposition without revision, whereas one RSA patient required revision for dislocation. These findings suggest that RSA offers superior long-term functional outcomes due to deterioration over time in the nonoperative group.
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