Delta Xtend reversed shoulder prosthesis.

Background of the study:

Displaced four-part fractures are among the most severe injuries and are positively correlated with age and osteoporosis. The optimal treatment for displaced four-part fractures is disputed. Recent systematic reviews emphasised that the limited evidence available does not confirm that surgery (i.e. hemiprosthesis) is preferable to conservative treatment in displaced fractures and concluded that published data are inadequate for evidence-based decision making. In a few recent studies promising results, in the management of four-part proximal humerus fractures, are mentioned with a reverse prosthesis. To our knowledge, the Delta Xtend reversed shoulder prosthesis has never been compared to conservative treatment in the management of displaced 4-part fractures of the proximal humerus.



Objective of the study:

Our primary objective is to compare the short-term (one-year follow-up) clinical results of the DePuy Delta Xtend reversed shoulder prosthesis with conservative treatment, in the management of displaced four-part fractures of the proximal humerus of elderly.



Study design:

Prospective single arm trial (Depuy, Delta Xtend reversed shoulder prosthesis) versus historical control group (conservative treatment).



Study population:

Patients diagnosed with displaced four-part fracture, > 70 years old.



Intervention:

A Delta Xtend reversed shoulder prosthesis will be inserted in all patients. All patients will receive a clinical and post clinical standardised rehabilitation program.



Primary study parameters/outcome of the study:

Difference in Constant Murley Score at 12 months between the intervention and historical control group.



Secundary study parameters/outcome of the study (if applicable):

Constant Murley score at 3 months. Visual analogue scale (VAS) for pain and impairment, range of motion (ROM), MecMesin myometer measurement of abduction force in Newton, and postoperative standing AP, axial and SOV radiographs at 3 and 12 months. Dutch simple shoulder test at 12 months.

Perioperative complications, postoperative complications and adverse events will be counted for type (% of total events) at
12 months.



Nature and extent of the burden and risks associated with participation, benefit and group relatedness:

The limited evidence available does not confirm that surgery (i.e. hemiprosthesis) is preferable to conservative treatment in displaced fractures. In recent studies promising results are mentioned with a reversed prosthesis. The potential risk of a Delta Xtend prosthesis (reversed shoulder prosthesis) is no different than with a hemiprosthesis, which is a fully accepted treatment of four-part fractures. The extra burden associated with participation in this study are the Constant Murley Score, the MecMesin Myometer abduction force test and the radiographs at 3 and 12 months and the Dutch simple shoulder test at 12 months.

Our primary objective is to compare the short-term (one-year follow-up) clinical results of the DePuy Delta Xtend reversed shoulder prosthesis with conservative treatment, in the management of displaced four-part fractures of the proximal humerus of elderly.

Follow-up at 1 week, 6 weeks, 3 months and 12 months.

A Delta Xtend reversed shoulder prosthesis will be inserted in all patients. All patients will receive a clinical and post clinical standardised rehabilitation program.



Prospective single arm trial (Depuy, Delta Xtend reversed shoulder prosthesis) versus historical control group (conservative treatment).