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Resume Introduction Avec le vieillissement de la population, le nombre de fractures deplacees de l’extremite superieure de l’humerus du sujet âge est en constante augmentation. Depuis une dizaine d’annees, la part de traitement par hemiarthroplastie (HA) tend a diminuer au profit de la prothese totale d’epaule inversee (PTEI). L’objectif de cette etude retrospective multicentrique etait d’evaluer les resultats de la PTEI fracture a court et long terme, sur une large cohorte de patients âges. Materiel et methode Au total, 898 patients d’âge moyen 79 ans ont ete inclus et 422 ont ete revus au recul minimum de 1 an, par un examen radio-clinique standardise. Certains patients ont ete revus 2 fois a des temps differents, ce qui a permis de constituer 2 groupes : 420 patients a moins de 5 ans de recul moyen (G1) et 119 a plus de 5 ans de recul moyen (G2). Resultats En moyenne, l’elevation anterieure active etait de 115° (± 29), la rotation externe 1 de 17° (± 19), la rotation interne dos de 4,3 points (± 2,5), le score de Constant absolu de 57 (± 15) et le score subjectif SSV de 70 % (± 18). La reinsertion des tuberosites aboutissant a leur consolidation en position anatomique permettait une amelioration significative de tous les resultats, en particulier sur les rotations. En cas d’echec de consolidation anatomique, le resultat clinique restait significativement meilleur qu’en cas d’excision des tuberosites. Les resultats cliniques a court terme (G1) et long terme (G2) etaient statistiquement identiques. Le taux de descellement humeral etait de 3,5 % et etait favorise par l’excision des tuberosites. Le taux de descellement glenoidien etait de 3,5 % et etait favorise par la position en tilt superieur de la glenosphere. La principale complication etait l’instabilite prothetique (2,5 %) et etait favorisee par l’excision des tuberosites. Le taux de survie post-operatoire des patients n’etait pas different de la population generale. Le taux de survie prothetique etait de 91 % a 20 ans. Conclusion Les resultats cliniques d’une PTEI pour fracture sont globalement satisfaisants mais surtout reproductibles et stables dans le temps. La reinsertion des tuberosites autour de la PTEI est l’element clef de l’intervention, permettant d’ameliorer le resultat fonctionnel, notamment par la restauration des rotations et la diminution du taux de complications (instabilite prothetique et descellement humeral). Niveau de preuve IV, etude retrospective.

Background The ageing of the population is steadily increasing the frequency of displaced proximal humerus fractures (PHFs) in elderly patients. The last decade has seen a shift from hemi-arthroplasty (HA) to reverse shoulder arthroplasty (RSA) in these patients. The primary objective of this study was to assess short- and long-term outcomes of RSA in a large cohort of elderly patients with recent PHFs. The secondary objectives were to evaluate radiological outcomes and short- and long-term morbidity and mortality rates. Hypothesis Outcomes of RSA to treat PHFs in older patients are satisfactory, reliable, and sustained over time. Material and methods This retrospective multi-centre study included 898 patients with a mean age of 79 years, among whom 422 underwent a standardised clinical and radiological evaluation at least 1 year after RSA. Some patients were re-evaluated twice. An evaluation within the first 5 years was available for 420 patients (≤ 5-Y group), whereas 119 patients were re-evaluated more than 5 years after RSA (> 5-Y group). Some patients had one re-evaluation either within or after 5 years and others had both an early and a late re-evaluation; thus the total number of re-evaluation was greater than the number of patients. Results Mean active forward elevation was 115° ± 29°, mean external rotation with the elbow by the side was 17° ± 19°, mean internal rotation (hand-to-back) was 4.3 ± 2.5 points, mean absolute Constant score was 57 ± 15, and mean Subjective Shoulder Value was 70% ± 18%. Re-implantation of the tuberosities followed by healing in the anatomical position was associated with significantly better outcomes, notably regarding rotations. Even in the absence of healing in the anatomical position, tuberosity repair was associated with better clinical outcomes compared to tuberosity excision. Humeral loosening occurred in 3.5% of patients and was associated with tuberosity excision. Glenoid loosening was seen in 3.5% of patients and was associated with superior tilt of the glenoid component. The main complication was prosthesis instability, which occurred in 2.5% of patients, a proportion similar to that seen in the general population. Post-operative patient survival was not significantly different from that in the general population of the same age. Prosthesis survival was 91% after 20 years. Conclusion Clinical outcomes of RSA for PHF in elderly patients were not only satisfactory but also reproducible and sustained over time. Tuberosity re-implantation around the prosthesis is the key step for optimising the functional outcomes, notably by restoring rotations and decreasing the risk of complications (prosthesis instability and humeral loosening). Level of evidence IV, retrospective observational study.