For patients over the age of 70, a complex shoulder fracture (specifically a proximal humeral fracture) is a life-altering injury. When the bone breaks into three or four pieces, the traditional debate has been: should we perform a Reverse Shoulder Replacement, or is it better to manage the injury non-operatively with a sling and therapy?

The Evidence: 2024 Randomized Controlled Trial

To provide the most up-to-date care at Kent Orthopaedic Practice, we look at the latest clinical trials. A significant study by Miquel J et al. (2024), published in the Journal of Shoulder & Elbow Surgery, recently addressed this exact question.

The study compared surgery to non-operative care in patients over 70 with acute, complex fractures. After a one-year follow-up, the results were definitive:

• • Superior Function: The surgical group scored significantly higher in shoulder function tests (Constant Score: 61.24) compared to those who did not have surgery (52.44).

• • Daily Living: Patients who underwent a Reverse Shoulder Replacement reported a much higher ability to perform daily activities—like dressing and reaching—independently.

• • Predictability: Surgery provided a more reliable outcome, whereas non-operative care often led to unpredictable healing and restricted movement.

Why “Reverse” Shoulder Replacement?

In older patients, these complex fractures often cannot be fixed with traditional plates and screws because the bone quality may be poor or the rotator cuff tendons may be damaged.

A Reverse Shoulder Replacement changes the mechanics of the joint. By reversing the “ball and socket,” the shoulder uses the large deltoid muscle to lift the arm instead of the damaged rotator cuff. This allows for excellent functional recovery even after a severe injury.

Clinical Commentary by Prof. Bijay Singh

As specialists in upper limb surgery, I see many patients who worry that they are “too old” for surgery. However, this 2024 evidence proves that for complex fractures, Reverse Shoulder Replacement is often the most effective way to maintain independence and quality of life. I perform one of the largest numbers of shoulder replacement in UK.

I have performed these regularly for over 15 years now and offer a day case and awake procedure.

Timing is critical. These fractures are best treated in the “acute” phase (shortly after the injury). An early consultation ensures that we can choose the right treatment path before the bone begins to heal in a poor position.

Key Takeaways for Patients

• • Restoration: Surgery is designed to restore your ability to perform daily tasks.

• • Evidence-Based: Modern studies support surgery as a primary option for complex 3 and 4-part fractures in seniors.

• • Safety: Performed by specialists, this is a safe and well-established procedure.

Resources & Next Steps If you or a loved one has suffered a shoulder injury, you can find more detailed information on our page.

To discuss your options with Prof. Bijayendra Singh, please at one of our Kent location