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Reverse shoulder arthroplasty for acute Neer type III and IV proximal humeral head fractures with different humeral stem inclination versus nonsurgical treatment: a prospective, single-blinded, randomized controlled trial

Year: 2026
Type: article
Abstract: Background: The optimal treatment of proximal humeral head fractures is controversial. Recently, reverse total shoulder arthroplasty (rTSA) has gained expanding popularity in treating PHFs. The aim of this study is to compare outcomes of 2 differently designed rTSAs versus nonoperative treatment in patients with Neer type III or IV PHFs. Methods: This randomized controlled trial compares the outcomes in patients with acute complex PHFs treated nonoperatively versus rTSA. Subgroups differ in inclination of the humeral neck-shaft-angle, 135° versus 155°. Patients 60 to 90 years of age with PHFs were allocated and block-randomized in this trial. The primary outcome is the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) at 1 year; secondary outcomes include Constant Murley score (CMS) in total and adjusted, subjective shoulder value (SSV), Disabilities of Arm, Shoulder and Hand (DASH), and elevation. Radiographs had been evaluated to state union/displacement or resorption of the fracture. The rate of healing of the tuberosities in the surgical group has been defined. Results: group. One periprosthetic joint infection underwent secondary surgery. Five crossovers in the nonoperative group were operated delayed. Conclusion: For Neer type III or IV (AO type B and C) proximal humeral head fractures in patients aged above 60 years, rTSA showed both clinically relevant and statistically significant superior outcomes compared with nonoperative treatment. Anatomical neck/shaft inclination of 135° was superior to HI 155°.
DOI: 10.1016/j.jseint.2026.101617
Language: English
Subfield: Surgery
Field: Medicine
Open Access status: gold
Estimated APC paid: $1,250
OpenAlex ID: W7124246649
FWCI:
Cites: 40
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