JSES - 2026-08-13 - Journal Article
Locking Plate Fixation with Cemented Screws versus Delta Xtend Reverse Shoulder Arthroplasty for Complex Proximal Humerus Fractures in the Elderly: A Matched-Pair Comparative Study.
Martinez-Catalan N, García-Rubio C, Valencia M, Luengo-Alonso G, Delgado C, Calvo E, Foruria AM
Topics
Key Takeaway
Cement-augmented locking plate fixation (ORIF-LPc) yielded superior external rotation (49° vs. 27°, p<0.001) compared to Delta Xtend rTSA for complex proximal humerus fractures in elderly patients, with equivalent Constant Scores, complication rates (21% vs. 19%), and revision rates (7% vs. 9%) at mean 4.7-year follow-up.
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Summary
This matched-pair study compared ORIF with cement-augmented locking plate (Philos with cemented screws) versus Delta Xtend rTSA in patients ≥65 years with complex proximal humerus fractures at a single institution from 2014–2023. ORIF-LPc produced significantly greater external rotation (49° vs. 27°) and internal rotation, but no differences in forward elevation, Constant Score, VAS pain, EQ-5D, complication rates (21% vs. 19%), or revision rates (7% vs. 9%). Both constructs achieved satisfactory functional outcomes, suggesting cement augmentation may rehabilitate ORIF-LP as a viable alternative to rTSA in this population.
Key Limitation
The retrospective matched-pair design cannot exclude selection bias in the allocation of patients to ORIF-LPc versus rTSA, as surgeon preference and intraoperative bone quality assessment likely influenced treatment assignment in ways not captured by the matching variables.
Original Abstract
INTRODUCTION
Due to the high complication rates associated with open reduction and internal fixation using locking plates (ORIF-LP) for complex proximal humerus fractures (PHFs) in elderly patients, many authors consider reverse shoulder arthroplasty (rTSA)the treatment of choice. However, the use of cemented screws in locked plating (ORIF-LPc) has been suggested to reduce implant-related complications. The aim of this matched-pair study was to compare clinical and radiographic outcomes, complication and revision surgery rates in patients older than 65 years with complex PHFs treated with cement-augmented locking plate fixation or reverse shoulder arthroplasty.
METHODS
Patients older thant 65 years with complex PHFs who underwent an ORIF-LPc (Philos, DePuy Synthes) were matched 1:1 with patients treated with Delta Xtend rTSA (DePuy Synthes, Warsaw, IN, USA) at a single institution between 2014 and 2023. Exclusion criteria included neurological injury, pathological or open fractures, absence of preoperative CT scan, and follow-up of less than 2 years. Fractures were classified according to the Mayo-FJD Classification. Clinical follow-up was conducted at 6 weeks, and at 3, 6, and 12 months, followed by annual assessments. Demographic data, range of motion, Constant Score (CS), Subjective Shoulder Value (SSV), pain with Visual Analog Scale (VAS), EuroQol-5D scores (EQ-5D), complication rates, and revision surgeries were analyzed. The mean follow-up was 4.7 ± 2.2 years (range 2.1-12.8 years). A p-value < 0.05 was considered statistically significant.
RESULTS
A total of 86 patients were included, with 43 patients in each group. The mean age was 75±7 years, 93% were female and 48% had dominant-side involvement. Patients treated with ORIF-LPc demonstrated significantly greater external rotation (49°±21° vs. 27°±19°, p<0.001) and internal rotation (median internal rotation: sacroiliac joint vs waist, p<0.001). No significant differences were observed in forward elevation (130°±37° vs. 136°±28°, p=0.634), CS (p=0.672), pain (p=0.704), or EuroQol-5D (EQ-5D) scores (p=0.25). No statistically significant differences were observed in complication rates (21% ORIF-LPc vs. 18.6% rTSA, p = 1.000) or revision surgery rates (7% ORIF-LPc vs. 9% rTSA, p = 1.000).
CONCLUSION
Both ORIF-LPc and Delta Xtend reverse shoulder arthroplasty were associated with satisfactory clinical outcomes. ORIF-LPc provided greater external and internal rotation, whereas no statistically significant differences were observed in overall functional outcomes, complication rates, or revision rates.