{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T04:10:01Z","timestamp":1749442201313,"version":"3.41.0"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T00:00:00Z","timestamp":1744502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82202705"],"award-info":[{"award-number":["82202705"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study provides a comparative analysis of clinical outcomes between primary and salvage reverse shoulder arthroplasty (RSA), offering valuable insights into the management of proximal humerus fracture (PHF). To evaluate the outcomes of patients treated with RSA as a primary procedure for acute PHF and to compare these with patients undergoing salvage RSA as a revision procedure for fracture sequelae of PHF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted on 42 patients undergoing RSA for PHF between December 2014 and April 2022. The primary RSA group (<jats:italic>n<\/jats:italic>\u2009=\u200928, mean age 73.8\u2009\u00b1\u20094.5\u2009years, 66\u201381\u2009years) included patients with acute fractures, while the salvage RSA group (<jats:italic>n<\/jats:italic>\u2009=\u200914, mean age 62.1\u2009\u00b1\u200912.3\u2009years, 47\u201383\u2009years) comprised revision cases for fracture sequelae. Active range of motion (ROM), Visual Analog Scale (VAS), Constant score, and American Shoulder and Elbow Surgeons (ASES) scores were assessed for all patients. Outcomes between the two groups were compared, along with radiographic outcomes and complications recorded at each follow\u2010up. Categorical variables were analyzed using chi\u2010square or Fisher's exact tests, while continuous variables were compared using independent <jats:italic>t<\/jats:italic>\u2010tests or Mann\u2013Whitney U tests based on data distribution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At a mean follow\u2010up of 56\u2009months (24\u2013106\u2009months), no significant differences in gender (<jats:italic>p<\/jats:italic>\u2009=\u20090.469) or follow\u2010up duration (<jats:italic>p<\/jats:italic>\u2009=\u20090.087) were observed. The salvage group exhibited comparable postoperative ROM (anterior flexion (AF): 101.4\u00b0\u2009\u00b1\u200952.3\u00b0 vs. 115.9\u00b0\u2009\u00b1\u200929.1\u00b0; external rotation (ER): 26.4\u00b0\u2009\u00b1\u200916.4\u00b0 vs. 28.8\u00b0\u2009\u00b1\u200914.1\u00b0; internal rotation (IR): 7\u2009\u00b1\u20092 vs. 7\u2009\u00b1\u20092; all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05) and clinical scores (VAS: 1.6\u2009\u00b1\u20091.9 vs. 1.2\u2009\u00b1\u20091.5; Constant: 74.1\u2009\u00b1\u200923.3 vs. 79.4\u2009\u00b1\u200915.9; ASES: 81.9\u2009\u00b1\u200915.4 vs. 84.0\u2009\u00b1\u200913.8; all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05) to the primary group. However, the salvage group demonstrated significant preoperative\u2010to\u2010postoperative improvements in AF (50.9\u00b0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), ER (5.4, <jats:italic>p<\/jats:italic>\u2009=\u20090.017), and functional scores (VAS: \u22124.6; Constant:\u2009+\u200936.9; ASES: +\u200945.8; all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Complications occurred in 14.3% of salvage cases (2 revisions for periprosthetic fracture and aseptic loosening) versus 3.6% in the primary group. No other major complications such as deep infection, instability, acromial stress fracture, or dislocation were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>RSA achieves comparable functional and radiographic outcomes for both acute PHF and fracture sequelae over 4\u2009years of follow\u2010up. Salvage RSA provides substantial clinical improvement but carries a higher complication risk, emphasizing the need for meticulous surgical technique and patient selection.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.70018","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T06:50:26Z","timestamp":1744613426000},"page":"1633-1643","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Clinical Outcomes Between Primary and Salvage Reverse Shoulder Arthroplasty for Proximal Humeral Fractures: A Retrospective Study"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3943-3511","authenticated-orcid":false,"given":"Qing","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery School of Medicine, West China Hospital, Sichuan University  Chengdu China"},{"name":"Department of Upper Limb Sichuan Provincial Orthpaedics Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-0843","authenticated-orcid":false,"given":"Sujan","family":"Shakya","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery School of Medicine, West China Hospital, Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Cao","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Chengdu University of Traditional Chinese Medicine  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Upper Limb Sichuan Provincial Orthpaedics Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1470-5805","authenticated-orcid":false,"given":"Zhou","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery School of Medicine, West China Hospital, Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery School of Medicine, West China Hospital, Sichuan University  Chengdu China"},{"name":"Department of Orthopedics The Fifth People's Hospital of Sichuan Province  Chengdu Sichuan China"},{"name":"Department of Orthopedics Ganzi\u00a0Tibetan Autonomous Prefecture People's Hospital  Ganzi Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/2471549220949731"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aott.2019.03.010"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181920e5b"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2010.12.018"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.4081\/or.2017.6977"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2009.06.004"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445\u20102197.2010.05342.x"},{"key":"e_1_2_12_9_1","first-page":"1610","article-title":"Unconstrained Shoulder Arthroplasty for Treatment of Proximal Humeral Nonunions","volume":"94","author":"Duquin T. R.","year":"2012","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.11.015"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-014-2651-0"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2008.09.015"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010011\u20102055\u2010z"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.07.044"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.06.035"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-015-2670-5"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-014-1980-1"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2011.01.042"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.01310"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.05.022"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00776\u2010011\u20100185\u20105"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2015.12.002"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2001.20905"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2022.12.020"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2007.03.016"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e31815bb09d"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2012.03.006"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e31818afe40"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000224"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS\u2010D\u201023\u201000740"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1067\/mse.2002.120914"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520931241"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.3944\/AOTT.2010.2272"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2004.01.020"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-014-2074-9"},{"key":"e_1_2_12_36_1","first-page":"1239","article-title":"Reverse Total Shoulder Replacement for Nonunion of a Fracture of the Proximal Humerus","volume":"96","author":"Zafra M.","year":"2014","journal-title":"Bone & Joint Journal"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.02.019"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000858"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1811-4"},{"key":"e_1_2_12_40_1","first-page":"2070","article-title":"Reverse Shoulder Arthroplasty for the Treatment of Nonunions of the Surgical Neck of the Proximal Part of the Humerus (Type\u20103 Fracture Sequelae)","volume":"96","author":"Raiss P.","year":"2014","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(13)70172-4"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T03:40:00Z","timestamp":1749440400000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,13]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1111\/os.70018"],"URL":"https:\/\/doi.org\/10.1111\/os.70018","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"type":"print","value":"1757-7853"},{"type":"electronic","value":"1757-7861"}],"subject":[],"published":{"date-parts":[[2025,4,13]]},"assertion":[{"value":"2024-10-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}