| Study | Population (n, mean age, % male) | Comparison | Fracture Type | Follow Up (Months, Outcome Measures) | Main Findings | Limitations | Conclusion |
|---|---|---|---|---|---|---|---|
| Gallinet 2009 | HHR n=17 74 (49-95) 12% male RSA n=16 74 (58-84) 19% male |
Short term Retrospective Non-randomized HHR done 1996-2001 RSA done 2002-2004 |
Three or four part displaced fractures | HHR 16.5mth (6-55) RSA 12.4mth (6-18) Active joint amplitude Constant DASH Standard X-ray |
RSA had better: -anterior elevation (97° vs. 54°)* -Abduction (91° vs. 60°)* -Constant (53 vs. 39)* HHR had better: -external rotation (14° vs. 9°) No difference in DASH 3 abnormal tuberosity fixations in HHR 15 glenoid notches in RSA |
Retrospective Non-randomized HHR vs. RSA was determined by year of Sx Small n Short follow up |
While clinical results were better for RSA, patient did not necessarily experience a benefit in quality of life (DASH) RSA only used in patients >70years. |
| Young 2010 | HHR n=10 75.5 20% male RSA n=10 77.2 0% male |
Retrospective Non-randomized HHR done from 2003-2005 RSA done from 2005-? |
Three and four part factures | HHR 44mth (24-56) RSA 22mth (16-37) Satisfaction ASES Oxford shoulder score X-rays |
No differences in outcome scores between groups Two complications in HHR |
Non-randomized Small n HHR vs. RSA was determined by year of Sx Different follow up periods |
The anticipated functional gains of RSA were not realized Larger prospective trials are needed. |
| Cuff 2013 | HHR n= 23 74.1 (70-88) 39% male RSA n=24 74.8 (70-86) 42% male |
prospective non-randomized 26 HHR pt. then 27 RSA pt |
4 Part, or 3 part w/ severe comminution of greater tuberosity, or split of humeral head | 30mth (24-48mth) ASES SST Satisfactory or not ROM Standard X-rays |
RSA had better: -ASES (77 vs. 62)* -SST (7.4 vs. 5.8)* -forward elevation (139° vs. 100°)* -satisfaction (91% vs. 61%)* -tuberosity healing (83% vs. 61%) (NS) Similar complication rates HHR success was dependent on tuberosity healing |
Non-randomized HHR had longer follow up No pre-op ASES or SST |
RSA had better clinical outcomes than HA HHR outcomes depended on tuberosity healing, RSA did not. |
| Baudi 2014 | HHR n=28 71.4 RSA N=25 77.3 7 male 46 female |
Retrospective Non-randomized Examined 3 ways: -whole group - >65 <75 ->75 |
Four part displacement fractures | 27.5mth (12-64 mth) Constant ASES DASH Strength in abduction, ER1, ER2 Standard X-rays |
Whole group RSA had better: -Constant (56 vs. 42)* - ASES (69 vs. 51)* -forward elevation (131° vs. 89°)* -abduction (128° vs. 82°)* -tuberosity consolidation (84% vs. 37%)* >65 <75 RSA had better: -Constant (61 vs. 37)* - forward elevation (135° vs. 77°) * -abduction (136° vs. 67°)* >75 RSA had better -Constant (52 vs. 40)* -ASES (67 vs. 46)* - forward elevation (125° vs. 35°)* -abduction (120° vs. 80°)* No differences in DASH |
Retrospective, non-randomized 3 types of prosthesis used Multiple comparisons and analyses performed No group characteristics Follow up is unclear |
Authors fail to make any definitive conclusion. |
| Boyle 2013 | 55 RSA (79.6 yrs, 7%) 313 HHR (71.9 yrs, 22%) |
Retrospective Registry Study | Acute proximal humerus fracture | Oxford Shoulder Score Mortality Revision |
OSS Same at 6/12 OSS at 5 years RSA=41.5 OSS at 5 years HHR=32.3 Revision and mortality same |
No radiographic evaluation No preop characteristics Unequal demographics |
RSA had higher functional scores at 5 year follow-up than HHR. |
| Chalmers 2014 | HHR=9 (age=72 Male= 25) RSA=9 (age=77 Male= 22) |
Retrospective Case-Controlled Cohort 9 RSA 9 HHR 9 ORIF |
Three and Four part displaced fractures from ground level fall | SF12 SST ASES ROM (AFE) Cost analysis |
No difference in ASES, SST or SF12 Faster and more predictable return of AFE RSA equal cost to ORIF, cheaper than HHR by ~$5000/patient |
Small, retrospective cohort study with short F/U No pre-op characteristics |
Significantly less expensive with better outcomes of RSA than HHR |
| Garrigues 2012 | 11 RSA 12 HHR |
Retrospective Review | 3 and 4 part fractures | F/U=3.6 years ASES, AFE, UPenn Shoulder Score, SANE |
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| Sebastia-Forcada 2014 | HHR n=30 73.3 (70-83) 17% male RSA n=31 74.7 (70-85) 13% male |
Prospective RCT Blinded HHR vs. RSA |
Displaced 4 part factures, fracture dislocations with 3 part fractures, head splitting with more than 40% articular surface involvement | HHR 27.7 mth (24-49) RSA 29.4 mth (24-44) Constant UCLA QuickDASH Standard X-rays |
RSA had better: -functional scores and active ROM (but not dif in internal rotation) -Constant (56 vs. 40)* -Pain [mild or non (14) vs. moderate or severe (8.8)]* -Anterior forward (120 vs. 79)* -UCLA score (29 vs. 21)* -DASH (17 vs. 24)* -rate of clinical failure (26% vs. 57%)* |
Low healing rate of tuberosities Short follow up limits interpretation of results. |
Significantly better functional outcome and revision rate were obtained with RSA Worst outcomes of HHR with failure of tuberosities to heal; but healing of tuberosities was not associated with RSA success |