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Suroto H, De Vega B, Deapsari F, et al. Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev. 2021;6(10):941-955doi: 10.1302/2058-5241.6.210049.
Suroto, H., De Vega, B., Deapsari, F., Prajasari, T., Wibowo, P. A., & Samijo, S. K. (2021). Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT open reviews, 6(10), 941-955. https://doi.org/10.1302/2058-5241.6.210049
Suroto, Heri, et al. "Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis." EFORT open reviews vol. 6,10 (2021): 941-955. doi: https://doi.org/10.1302/2058-5241.6.210049
Suroto H, De Vega B, Deapsari F, Prajasari T, Wibowo PA, Samijo SK. Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev. 2021 Oct 19;6(10):941-955. doi: 10.1302/2058-5241.6.210049. eCollection 2021 Oct. PMID: 34760293; PMCID: PMC8559569.
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EFORT Open Rev. 2021 Oct 19;6(10):941-955. doi: 10.1302/2058-5241.6.210049. eCollection 2021 Oct.

Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis.

EFORT open reviews

Heri Suroto, Brigita De Vega, Fani Deapsari, Tabita Prajasari, Pramono Ari Wibowo, Steven K Samijo

Affiliations

  1. Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia.
  2. These authors contributed equally to this work.
  3. Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.
  4. Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
  5. Department of Orthopaedics and Traumatology Zuyderland Medisch Centrum, Heerlen, the Netherlands.

PMID: 34760293 PMCID: PMC8559569 DOI: 10.1302/2058-5241.6.210049

Abstract

Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies.We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach.Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively).RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article:

© 2021 The author(s).

Keywords: humeral fractures; internal fracture fixation; meta-analysis; shoulder fractures; shoulder replacement arthroplasty; systematic review

Conflict of interest statement

ICMJE Conflict of interest statement: The authors declare no conflict of interest in this study.

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