Medium-term results of four-part proximal humerus fractures treated with osteosynthesis and reverse shoulder arthtoplasty

Background. Four-part fractures of the proximal humerus (PHF) present difficulties in choosing a treatment method. The aim of the study. Evaluate medium-term results of four-part proximal humerus fractures treated with osteosynthesis and reverse shoulder arthtoplasty Methods. The study included patients with a four-part PHF who underwent surgery at the Pirogov State Clinical Hospital No. 1 in the period from 2020 to 2023. Patients were divided into two groups: the osteosynthesis group (O, n = 46) and the reverse arthroplasty (RSA) group (E, n = 35). We conducted a survey in both groups using a specially developed questionnaire of subjective assessments. According to the survey results, a matrix of feature correlations was constructed within each group using the Kendall criterion. We used the Mann-Whitney test with the calculation of the p-criterion to assess the differences between the E and O groups. Results. Mann-Whitney test showed no significant difference in clinical results one year after osteosynthesis and RSA of the shoulder joint. However, in groups O and E, different criteria were identified as more significant in subjective assessment of the fracture treatment outcome. Two criteria were statistically significant in E group: restriction of movement in the upper limb and the percentage of restoration of upper limb function. In O group, in addition to the above-mentioned signs, the VAS point and the assessment of personal contribution to the rehabilitation after surgery became prognostic factors in evaluating treatment. Conclusion. In four-part PHF, we can expect comparable results using both plate osteosynthesis and RSA as treatment methods. Our study highlights the importance of a subjective assessment of quality of life and patient satisfaction, which are important components of clinical decision-making in the treatment of four-part PHF.