Abstract
Introduction. Recent studies highlight the growing concern regarding the increasing number of proximal humerus fractures, the severity of which escalates with age due to the progressive decline in bone mineral density. Recommendations from the European Society for Trauma and Emergency Surgery emphasize a growing trend toward reverse shoulder arthroplasty in elderly patients.
Objective. To analyze the short-term functional outcomes of implementing an original modular reverse total shoulder prosthesis in the surgical treatment of patients with proximal humerus fractures or their sequelae in the context of reduced bone mineral density.
Methods. A prospective study was conducted on a group of 14 patients who met the following inclusion criteria: age ≥ 50 years; proximal humerus fracture type 11-B or 11-C according to AO/OTA classification; significantly reduced bone mineral density with a cortical index ≤ 0.4.
Surgical intervention was performed using an original modular reverse total shoulder prosthesis based on additive manufacturing technologies. Shoulder joint function was evaluated using the Constant-Murley Shoulder Score at 3, 6, and 12 months postoperatively. Differences in functional outcomes were assessed using Tukey’s test at a significance level of p < 0.05 based on one-way analysis of variance.
Results. The mean age of patients was (65.0 ± 7.8) years. All patients had significantly reduced bone mineral density, and more than half (8 individuals, 57.1%) had a cortical index in the range of 0.30–0.38. The mean time from injury to surgery was (82.3 ± 70.5) days. The developed modular prosthesis was used in patients with substantial proximal humerus defects on the background of reduced bone mineral density, as well as following failed open reduction and internal fixation.
Conclusions. A statistically significant (p < 0.05) improvement in the functional outcomes of patients in the study group at 12 months postoperatively confirmed the feasibility of using a porous titanium modular reverse shoulder prosthesis manufactured with additive 3D technologies in type 11-B and 11-C fractures with reduced bone mineral density in patients over 50 years of age with proximal humerus defects. The complication rate of 28.6% in the study group did not exceed the average values reported in comparable studies by other authors.