Fewer major complications but more pain in reverse shoulder arthroplasty compare with open reduction internal fixation in closed proximal humerus fracture: a National database study

BACKGROUND: The incidence of closed proximal humerus fractures (CPHF) is steadily increasing worldwide. Open reduction internal fixation (ORIF) remains the most common surgical technique while reverse shoulder arthroplasty (RSA) is becoming a noteworthy approach. The optimal management of CPHF (ORIF vs. RSA) remains complex and continually evolving. METHODS: This retrospective cohort study utilized data from the National Inpatient Sample (2016-2019). Patients with proximal humerus fractures (PHF) treated with ORIF or RSA were included. Demographics, fracture characteristics, comorbidities, and complications were analyzed. Binary logistic regression identified risk factors for complications. RESULTS: A total of 11,667 patients with CPHF were included (ORIF, n = 2,657 vs. RSA, n = 1,932). Patients undergoing ORIF were younger and incurred lower hospital charges (P < 0.001). Female gender, elective admission rate, and Charlson comorbidity index were significantly higher in those who underwent RSA. Both groups differed in rates of major complications and postprocedural pain (P < 0.001). Implant-related complications (P = 0.046) and total complications (P = 0.157) showed no significant difference. For patients undergoing RSA, those with 3-part fractures (OR = 0.08, 95% CI 0.01-0.50, P = 0.006) and 4-part fractures (OR = 0.04, 95% CI 0.01-0.23, P < 0.001) had significantly lower odds of implant-related complications compared to those with 1-part fractures. CONCLUSION: RSA may be a considered option for elderly patients with 3- or 4-part fractures and significant comorbidities, as it was associated with fewer major complications and served as a protective factor for implant-related issues. ORIF presents a viable option for 1- or 2-part fractures, given its association with lower postprocedural pain. LEVEL OF EVIDENCE: Level III.