{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:43:32Z","timestamp":1793148212800,"version":"4.5.0"},"reference-count":58,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T00:00:00Z","timestamp":1717632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged &gt;65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant\u2013Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.<\/jats:p>","DOI":"10.3390\/jcm13113344","type":"journal-article","created":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T03:44:35Z","timestamp":1717645475000},"page":"3344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5864-7454","authenticated-orcid":false,"given":"Thomas P.","family":"Bosch","sequence":"first","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland"},{"name":"Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J. P.","family":"Beeres","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland"},{"name":"Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Ferree","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inger B.","family":"Schipper","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland S.","family":"Camenzind","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben J.","family":"Hoepelman","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3289-6935","authenticated-orcid":false,"given":"Bj\u00f6rn-Christian","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingmar F.","family":"Rompen","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-1358","authenticated-orcid":false,"given":"Reto","family":"Babst","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland"},{"name":"Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J. M.","family":"van de Wall","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland"},{"name":"Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of Adult Fractures: A Review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11999-012-2454-9","article-title":"Classifications in Brief: The Neer Classification for Proximal Humerus Fractures","volume":"471","author":"Carofino","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","first-page":"407","article-title":"Study and Development of a New Shoulder Prosthesis","volume":"39","author":"Grammont","year":"1987","journal-title":"Rhumatologie"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.jse.2011.04.016","article-title":"Hemiarthroplasty Versus Nonoperative Treatment of Displaced 4-Part Proximal Humeral Fractures in Elderly Patients: A Randomized Controlled Trial","volume":"20","author":"Olerud","year":"2011","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.jse.2010.12.018","article-title":"Internal Fixation Versus Nonoperative Treatment of Displaced 3-Part Proximal Humeral Fractures in Elderly Patients: A Randomized Controlled Trial","volume":"20","author":"Olerud","year":"2011","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/1758573219831506","article-title":"Comparison of Surgical and Non-Surgical Treatments for 3- and 4-Part Proximal Humerus Fractures: A Network Meta-Analysis","volume":"12","author":"Orman","year":"2020","journal-title":"Shoulder Elb."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.2106\/JBJS.L.01637","article-title":"Comparison of Hemiarthroplasty and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humeral Fractures in Elderly Patients","volume":"95","author":"Cuff","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2106\/JBJS.19.01071","article-title":"Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial","volume":"102","author":"Fraser","year":"2020","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.injury.2019.01.034","article-title":"The Increasing Role of Reverse Total Shoulder Arthroplasty in the Treatment of Proximal Humerus Fractures","volume":"50","author":"Dillon","year":"2019","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0020-1383(97)00211-8","article-title":"Non-Operative Treatment of Comminuted Fractures of the Proximal Humerus in Elderly Patients","volume":"29","author":"Zyto","year":"1998","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1302\/0301-620X.93B6.25596","article-title":"The Outcome of Fractures in Very Elderly Patients","volume":"93-B","author":"Clement","year":"2011","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The Prisma Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-Analysis of Observational Studies in Epidemiologya Proposal for Reporting","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1016\/j.jse.2019.06.024","article-title":"Reverse Shoulder Arthroplasty Versus Nonoperative Treatment for 3- or 4-Part Proximal Humeral Fractures in Elderly Patients: A Prospective Randomized Controlled Trial","volume":"28","author":"Lopiz","year":"2019","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jse.2018.07.019","article-title":"Three- and Four-Part Displaced Proximal Humeral Fractures in Patients Older Than 70 Years: Reverse Shoulder Arthroplasty or Nonsurgical Treatment?","volume":"28","author":"Chivot","year":"2019","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.jse.2016.10.013","article-title":"Nonoperative Management Versus Reverse Shoulder Arthroplasty for Treatment of 3- and 4-Part Proximal Humeral Fractures in Older Adults","volume":"26","author":"Roberson","year":"2017","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s12306-014-0321-4","article-title":"Reverse Shoulder Arthroplasty without Subscapularis Repair for the Treatment of Proximal Humeral Fractures in the Elderly","volume":"98","author":"Grassi","year":"2014","journal-title":"Musculoskelet. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1016\/j.jse.2016.02.024","article-title":"Reverse Total Shoulder Arthroplasty for Acute Head-Splitting, 3- and 4-Part Fractures of the Proximal Humerus in the Elderly","volume":"25","author":"Grubhofer","year":"2016","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/BOT.0b013e31818afe40","article-title":"Treatment of Comminuted Fractures of the Proximal Humerus in Elderly Patients with the Delta Iii Reverse Shoulder Prosthesis","volume":"22","author":"Klein","year":"2008","journal-title":"J. Orthop. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1796","DOI":"10.1016\/j.jse.2020.01.073","article-title":"Surgical Treatment of Complex Proximal Humeral Fractures in Elderly Patients: A Matched-Pair Analysis of Angular-Stable Plating Vs. Reverse Shoulder Arthroplasty","volume":"29","author":"Klug","year":"2020","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3324","DOI":"10.1007\/s11999-011-2055-z","article-title":"Is Reverse Shoulder Arthroplasty Appropriate for the Treatment of Fractures in the Older Patient? Early Observations","volume":"469","author":"Lenarz","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s00264-015-3085-z","article-title":"Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures in the Geriatric Patient: Results, Health-Related Quality of Life and Complication Rates","volume":"40","author":"Lopiz","year":"2016","journal-title":"Int. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.injury.2019.09.019","article-title":"Primary Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures: A 5-Year Long Term Retrospective Study of Elderly Patients","volume":"50","author":"Luciani","year":"2019","journal-title":"Injury"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1016\/j.jse.2018.05.030","article-title":"How the Greater Tuberosity Affects Clinical Outcomes after Reverse Shoulder Arthroplasty for Proximal Humeral Fractures","volume":"27","author":"Ohl","year":"2018","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s12306-017-0451-6","article-title":"Surgical Management of Complex Proximal Humeral Fractures: Pinning, Locked Plate and Arthroplasty: Clinical Results and Functional Outcome on Retrospective Series of Patients","volume":"101","author":"Repetto","year":"2017","journal-title":"Musculoskelet. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s00590-020-02649-8","article-title":"Tuberosity Healing Improves Functional Outcome Following Primary Reverse Shoulder Arthroplasty for Proximal Humeral Fractures with a 135\u00b0 Prosthesis","volume":"30","author":"Schmalzl","year":"2020","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s12306-014-0322-3","article-title":"Hemiarthroplasty Versus Reverse Shoulder Arthroplasty: Comparative Study of Functional and Radiological Outcomes in the Treatment of Acute Proximal Humerus Fracture","volume":"98","author":"Baudi","year":"2014","journal-title":"Musculoskelet. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1016\/j.jse.2014.06.035","article-title":"Reverse Shoulder Arthroplasty Versus Hemiarthroplasty for Acute Proximal Humeral Fractures. A Blinded, Randomized, Controlled, Prospective Study","volume":"23","year":"2014","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1097\/BOT.0000000000001348","article-title":"Effect of Tuberosity Healing on Clinical Outcomes in Elderly Patients Treated with a Reverse Shoulder Arthroplasty for 3- and 4-Part Proximal Humerus Fractures","volume":"33","author":"Simovitch","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"230","DOI":"10.3928\/01477447-20160610-03","article-title":"Cost Analysis of Hemiarthroplasty Versus Reverse Shoulder Arthroplasty for Fractures","volume":"39","author":"Solomon","year":"2016","journal-title":"Orthopedics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2309499018760132","DOI":"10.1177\/2309499018760132","article-title":"Reverse Shoulder Arthroplasty for the Treatment of Acute Complex Proximal Humeral Fractures: Influence of Greater Tuberosity Healing on the Functional Outcomes","volume":"26","author":"Torrens","year":"2018","journal-title":"J. Orthop. Surg."},{"key":"ref_32","first-page":"442","article-title":"Mid-Term Outcome of Reverse Shoulder Prostheses in Complex Proximal Humeral Fractures","volume":"78","author":"Valenti","year":"2012","journal-title":"Acta Orthop. Belg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jse.2017.02.005","article-title":"Reverse Shoulder Arthroplasty Compared with Hemiarthroplasty in the Treatment of Acute Proximal Humeral Fractures","volume":"26","author":"Boyle","year":"2017","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.jse.2017.01.021","article-title":"Reverse Shoulder Arthroplasty for Complex Fractures of the Proximal Humerus in Elderly Patients: Impact on the Level of Independency, Early Function, and Pain Medication","volume":"26","author":"Wolfensperger","year":"2017","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1097\/BOT.0000000000001465","article-title":"Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures","volume":"33","author":"Wright","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/j.1445-2197.2010.05342.x","article-title":"Comparison of Functional Outcomes of Reverse Shoulder Arthroplasty Versus Hemiarthroplasty in the Primary Treatment of Acute Proximal Humerus Fracture","volume":"80","author":"Young","year":"2010","journal-title":"ANZ J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1097\/BOT.0000000000000136","article-title":"Functional and Quality-of-Life Results of Displaced and Nondisplaced Proximal Humeral Fractures Treated Conservatively","volume":"28","author":"Bogner","year":"2014","journal-title":"J. Orthop. Trauma"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.otsr.2016.02.014","article-title":"Hemiarthroplasty Versus Reverse Shoulder Arthroplasty in 4-Part Displaced Fractures of the Proximal Humerus: Multicenter Retrospective Study","volume":"102","author":"Bonnevialle","year":"2016","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jse.2012.03.006","article-title":"Functional Outcomes of Reverse Shoulder Arthroplasty Compared with Hemiarthroplasty for Acute Proximal Humeral Fractures","volume":"22","author":"Boyle","year":"2013","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1302\/0301-620X.92B4.22450","article-title":"The Reverse Shoulder Prosthesis in the Treatment of Fractures of the Proximal Humerus in the Elderly","volume":"92","author":"Cazeneuve","year":"2010","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.otsr.2019.03.019","article-title":"Reverse Shoulder Arthroplasty for Recent Proximal Humerus Fractures: Outcomes in 422 Cases","volume":"105","author":"Gallinet","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e703","DOI":"10.3928\/01477447-20120426-25","article-title":"Hemiarthroplasty Versus Reverse Total Shoulder Arthroplasty for Acute Proximal Humerus Fractures in Elderly Patients","volume":"35","author":"Garrigues","year":"2012","journal-title":"Orthopedics"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2151459320915321","DOI":"10.1177\/2151459320915321","article-title":"Reverse Total Shoulder Arthroplasty for Treatment of 3- and 4-Part Proximal Humeral Fractures: Clinical and Radiological Analysis with Minimum Follow-up of 2 Years","volume":"11","author":"Barbosa","year":"2020","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3483","DOI":"10.1007\/s11999-012-2531-0","article-title":"Hemiarthroplasty for Humeral Four-Part Fractures for Patients 65 Years and Older: A Randomized Controlled Trial","volume":"470","author":"Boons","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00068-017-0890-7","article-title":"Outcomes of Operative and Nonoperative Treatment of 3- and 4-Part Proximal Humeral Fractures in Elderly: A 10-Year Retrospective Cohort Study","volume":"45","author":"Brouwer","year":"2019","journal-title":"Eur. J. Trauma. Emerg. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1302\/0301-620X.96B7.32894","article-title":"The Outcome of Proximal Humeral Fractures in the Elderly: Predictors of Mortality and Function","volume":"96-B","author":"Clement","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1001\/jama.2015.1629","article-title":"Surgical vs. Nonsurgical Treatment of Adults with Displaced Fractures of the Proximal Humerus: The Profher Randomized Clinical Trial","volume":"313","author":"Rangan","year":"2015","journal-title":"JAMA"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.jse.2015.12.002","article-title":"Outcomes of Reverse Total Shoulder Arthroplasty as Primary Versus Revision Procedure for Proximal Humerus Fractures","volume":"25","author":"Dezfuli","year":"2016","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jse.2021.07.003","article-title":"Acute Versus Delayed Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures: A Consecutive Cohort Study","volume":"31","author":"Panagopoulos","year":"2022","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S175","DOI":"10.1016\/j.jse.2019.01.026","article-title":"Primary Reverse Shoulder Arthroplasty Using Contemporary Implants Is Associated with Very Low Reoperation Rates","volume":"28","author":"Kang","year":"2019","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jse.2017.09.013","article-title":"Quantifying Success after Total Shoulder Arthroplasty: The Minimal Clinically Important Difference","volume":"27","author":"Simovitch","year":"2018","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.2106\/00004623-200211000-00002","article-title":"Open Reduction and Internal Fixation of Three and Four-Part Fractures of the Proximal Part of the Humerus","volume":"84","author":"Wijgman","year":"2002","journal-title":"JBJS"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"454","DOI":"10.2106\/JBJS.16.00223","article-title":"Long-Term Outcomes of Reverse Total Shoulder Arthroplasty: A Follow-up of a Previous Study","volume":"99","author":"Bacle","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.jse.2017.11.028","article-title":"Long-Term Humeral Complications after Grammont-Style Reverse Shoulder Arthroplasty","volume":"27","author":"Ascione","year":"2018","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_55","unstructured":"United Nations (2019). World Population Prospects 2019: Highlights, United Nations, Department of Economic and Social Affairs, Population Division."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.aap.2016.04.003","article-title":"The Economic Burden of Injury: Health Care and Productivity Costs of Injuries in the Netherlands","volume":"93","author":"Polinder","year":"2016","journal-title":"Accid. Anal. Prev."},{"key":"ref_57","unstructured":"Erixon, F., and van der Marel, E. (2011). What Is Driving the Rise in Health Care Expenditures? An Inquiry into the Nature and Causes of the Cost Disease, European Centre for International Political Economy."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1097\/CORR.0000000000002219","article-title":"Reverse Total Shoulder Arthroplasty Is the Most Cost-Effective Treatment Strategy for Proximal Humerus Fractures in Older Adults: A Cost-Utility Analysis","volume":"480","author":"Humphries","year":"2022","journal-title":"Clin. Orthop. Relat. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/11\/3344\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:54:32Z","timestamp":1760108072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/11\/3344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,6]]},"references-count":58,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13113344"],"URL":"https:\/\/doi.org\/10.3390\/jcm13113344","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,6]]}}}