2025 ISAKOS Biennial Congress ePoster
The DFER Approach For Reverse Shoulder Arthroplasty In Acute Proximal Humerus Fractures
Kristine R. Italia, MD, FPOA, Quezon City, Metro Manila PHILIPPINES
Roberto Pareyon MEXICO
Mohammad Jomaa LEBANON
Jashint Maharaj, MBBS, FRSPH, Brisbane, QLD AUSTRALIA
Kenneth Cutbush, MBBS, FRACS, FAOrthA, Spring Hill, QLD AUSTRALIA
Ashish Gupta, MBBS, MSc, FRACS, FAORTHOA, Brisbane, QLD AUSTRALIA
Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, QLD, AUSTRALIA
FDA Status Not Applicable
Summary
The purpose of this study is to show the surgical technique and the outcomes of RSA for comminuted PHF in the elderly using an approach based on 4 important principles: Delayed surgery; Functional tuberosity reattachment; External rotation abduction brace; early Rehabilitation (DFER).
ePosters will be available shortly before Congress
Abstract
Introduction
Reverse shoulder arthroplasty (RSA) has been increasingly used in cases of comminuted proximal humeral fractures (PHF) in the elderly. Literature demonstrated the importance of tuberosity reattachment and healing to ensure satisfactory outcomes postoperatively. The purpose of this study is to show the surgical technique and the outcomes of RSA for comminuted PHF in the elderly using an approach based on 4 important principles: Delayed surgery; Functional tuberosity reattachment; External rotation abduction brace; early Rehabilitation (DFER).
Methods
Consecutive patients with comminuted PHF who underwent RSA following the DFER approach performed by a senior fellowship-trained shoulder subspecialist from 2016 to May 2022 were included in the study. The approach involves delaying the surgery for at least 2 weeks to allow consolidation of tuberosities for better handling, functional reattachment of the tuberosities for tensionless repair, immobilisation using external rotation brace with 60-degree abduction, and early rehabilitation for range of motion. Clinical and functional outcome measures were recorded preoperatively and at 6, 12 and 24-months postoperatively. These included range of motion, VAS, Constant Score, and ASES score. Subgroup analysis of outcomes between those who had good postoperative rehabilitation and those who failed to comply was also done. CT scan at 3-months postoperatively were conducted as part of standard clinical practice to assess tuberosity healing.
Results
A total of 37 patients were included in the study, with a mean age of 72 (range 53-88). At a mean follow-up of 24 months, improvement in pain (VAS of 1 vs 6 preoperatively), Constant score (64 vs 7 preoperatively), and ASES score (84 vs 22 preoperatively) were observed. Mean forward flexion improved from 12 to 148 degrees, lateral elevation from 10 to 142 degrees, external rotation from 0 to 42 degrees, and internal rotation from 0 to 54 degrees. Subgroup analysis in terms of compliance with rehabilitation showed that patients who were compliant with physiotherapy compared to those who were not compliant (n=6) showed better pain (compliant VAS 1 vs noncompliant VAS 2), forward flexion (145 vs 130 degrees noncompliant), lateral elevation (136 vs 122 degrees), external rotation (43 vs 33 degrees), Constant score (63 vs 51) and ASES score (86 vs 73). CT scans at 3 months postoperatively showed 100% healing of the tuberosities.
Conclusion
The DFER approach results in satisfactory outcomes in RSA for acute PHF. It ensures rigid tuberosity fixation and early active mobilization following surgery. Patients who were not able to follow the prescribed rehabilitation protocol did not do as well as those who were compliant with physiotherapy, proving the importance of compliance with prescribed rehabilitation postoperatively.