Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 12, pp 1649–1657 | Cite as

Non-fracture stem vs fracture stem of reverse total shoulder arthroplasty in complex proximal humeral fracture of asian elderly

  • Jae-Jung Jeong
  • Chae-Gwan Kong
  • Sang-Eun Park
  • Jong-Hun JiEmail author
  • Won-Ha Whang
  • Bong-Seok Choi
Orthopaedic Surgery



Fracture stem of the reverse total shoulder arthroplasty (RTSA) was designed for better tuberosity bone healing for the proximal bone defect of complex proximal humeral fractures (PHF). Our purpose was to compare the clinical and radiological outcomes of patients using fracture stem vs non-fracture (conventional) stem of RTSA in complex PHF of elderly patients.


Between 2008 March and 2017 June, 48 patients who had undergone an RTSA with non-fracture or fracture stem for complex PHF with a minimum 18 months of follow-up were evaluated. Finally, total 45 patients with a mean age of 80 ± 7 years (65–92 years) were enrolled because three patients were excluded due to age related mortality. We divided them into two groups: 25 patients using non-fracture stem (non-fracture stem group) in the early period of this study, and consecutive 20 patients using fracture stem (fracture stem group) in the later period. Between two groups, we compared clinical and radiologic outcomes such as tuberosity failure, heterotopic ossification (HO), dislocation, acromion fracture, notching, loosening and periprosthetic fracture.


In all patients, clinical outcomes were improved significantly and tuberosity failure was found in 62% (28/45). Between two groups, there were no statistically significant differences on clinical outcomes and radiologic outcomes except UCLA score. As complications, two humeral stem revision was performed due to tuberosity failure related HO and stem loosening with subsequent periprosthetic fracture in non-fracture stem group.


Compared to non-fracture stem, fracture stem usage of RTSA in complex PHF of elderly patients has no significant different impact on clinical and radiological outcomes. However, tuberosity failure related secondary HO of non-fracture stem might be responsible for stem loosening and periprosthetic fracture in the RTSA for complex PHF of elderly patients.

Level of evidence

Level IV, case series study.


Complex proximal humeral fractures Reverse total shoulder arthroplasty Fracture stem Non-fracture (conventional) stem Stem loosening 



No author or related institute has received any financial benefit from research in this study. Institutional Review Board: approved by Daejeon St. Mary’s Hospital # DC17RESI0067

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaDaejeonSouth Korea
  2. 2.Department of Orthopaedic Surgery, Ujeongbu St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaUijeongbu-siSouth Korea

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