{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:57:46Z","timestamp":1781647066577,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma La Sapienza"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal management of displaced proximal humerus fractures (PHFs) in the elderly remains a subject of ongoing debate. This study aims to compare the clinical and functional outcomes of biologically driven external fixation (EF) versus functional joint replacement via reverse shoulder arthroplasty (RSA) in patients aged 65-80 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective comparative study was conducted on patients with displaced Neer two- or three-part\u00a0PHFs\u00a0treated between 2015 and 2022. The final analysis included 67 patients: Group A (EF; n=34) and Group B (RSA; n=33). Clinical and functional outcomes were quantified using the Constant-Murley Score (CMS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, and Range of Motion (ROM) assessment. Patient satisfaction was evaluated via a 5-point Likert scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both cohorts were homogeneous regarding mean age (72.2 \u00b1 3.5 vs. 73.4 \u00b1 3.8 years). Group A demonstrated significantly shorter mean operative times (48.2 \u00b1 10.5 vs. 92.4 \u00b1 15.2 min; p &lt; 0.001) and a lower requirement for blood transfusions (0% vs. 12.1%; p &lt; 0.05). At the final follow-up, both cohorts achieved comparable\u00a0CMS\u00a0(58.4 \u00b1 8.2 vs. 55.2 \u00b1 10.1; p = 0.42),\u00a0SST\u00a0(7.6 \u00b1 1.5 vs. 7.0 \u00b1 1.4; p = 0.38), and\u00a0ASES\u00a0scores (69 \u00b1 7.8 vs. 65 \u00b1 9.4; p = 0.51). Group A exhibited significantly superior external rotation (60.9\u00b0 \u00b1 9.2\u00b0 vs. 46.5\u00b0 \u00b1 10.1\u00b0; p &lt; 0.01) and a trend toward better internal rotation (49\u00b0 \u00b1 16.2\u00b0 vs. 42\u00b0 \u00b1 17.1\u00b0; p = 0.09). Subjective satisfaction was comparable (Likert score: 3.2 \u00b1 0.8 vs. 2.9 \u00b1 0.9; p = 0.16). The overall complication rate was 20.6% in Group A and 12.1% in Group B (p = 0.51).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Both\u00a0EF\u00a0and\u00a0RSA\u00a0are effective for managing\u00a0PHFs\u00a0in the elderly, yielding similar functional outcomes. However,\u00a0EF\u00a0represents a significantly less invasive, \"bio-friendly\" alternative, offering shorter surgical duration, no transfusion risk, and superior restoration of physiological rotations. The preservation of native anatomy and high patient satisfaction support\u00a0EF\u00a0as a viable treatment option in the geriatric population\n                      <jats:bold>.<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, Retrospective Comparative Study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06286-4","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T15:56:13Z","timestamp":1775490973000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External fixation versus reverse shoulder arthroplasty for proximal humerus fractures in the elderly: a retrospective comparative study"],"prefix":"10.1007","volume":"146","author":[{"given":"Antonio","family":"Vadal\u00e0","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano","family":"Benelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Suraci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetto","family":"Carta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Baldassari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"6286_CR1","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/000164701753542023","volume":"72","author":"CM Court-Brown","year":"2001","unstructured":"Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. 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