{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:52:02Z","timestamp":1785174722387,"version":"3.55.0"},"reference-count":44,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Shoulder and Elbow Arthroplasty"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>in the elderly patient population, where fracture comminution, osteoporotic fractures, and associated arthritis or rotator cuff pathologies dominate, metadiaphyseal proximal humeral fracture is a challenging subset of fractures to treat. This study reports on cementless long-stem reverse total shoulder arthroplasty (RTSA) as primary treatment of metadiaphyseal proximal humeral fractures in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials &amp; Methods<\/jats:title>\n                    <jats:p>Between January 2018 and October 2021, 22 consecutive patients sustained proximal humerus fractures with metadiaphyseal extension and underwent surgery with cementless long-stem RTSA. Patients older than 60 years with minimum 1 year of clinical and radiographic follow-up were included. Patient demographics, range of motion, and patient reported outcomes [Visual Analog Scale (VAS) pain scale, Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), and American Shoulder Elbow Surgeon (ASES) scores] were retrospectively collected. Postoperative X-rays were evaluated for fracture and tuberosity union.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 14 eligible patients with a median age of 71 years (range 61-91 years) and a median 13 months follow-up. At final follow-up, the median active elevation was 120\u00b0 (range 80\u00b0-150\u00b0), external rotation was 40\u00b0 (range 0\u00b0-50\u00b0), and internal rotation was 40\u00b0 (range 0\u00b0-80\u00b0). Median VAS was 2 (range 0-8), SST was 71% (range 33%-92%), SSV was 78% (range 20-90%), and ASES was 73 (range 17-90). All patients exhibited radiographic union. There were five minor complications in three patients: postoperative neuropathy, tuberosity nonunion, scapula notching, and proximal humeral stress shielding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cementless long-stem RTSA is a viable alternative to primary fracture fixation in the elderly patient population with metadiaphyseal proximal humerus fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24715492231192055","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T02:36:56Z","timestamp":1691030216000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Arthroplasty as Primary Treatment for Metadiaphyseal Proximal Humerus Fractures: A Viable Alternative to Osteosynthesis for the Elderly"],"prefix":"10.1016","volume":"7","author":[{"given":"Asadullah","family":"Helal","sequence":"first","affiliation":[{"name":"The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Heimdal","sequence":"additional","affiliation":[{"name":"The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddie Y","family":"Lo","sequence":"additional","affiliation":[{"name":"The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Montemaggi","sequence":"additional","affiliation":[{"name":"AOUP- Cisanello Hospital, Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Lund","sequence":"additional","affiliation":[{"name":"The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Upper Limb Unit, F Miulli Hospital, Acquaviva Delle Fonti, Bari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7992-709X","authenticated-orcid":false,"given":"Alvin","family":"Ouseph","sequence":"additional","affiliation":[{"name":"The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"The 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