Search Results (193)

Background/Objectives: Proximal humerus fractures account for approximately 5% of all skeletal injuries, and their optimal surgical management remains debated. The optimal fixation method for three-part proximal humerus fractures remains a matter of debate. This study aimed to compare the clinical and radiological outcomes of two minimally invasive osteosynthesis techniques—plate fixation and intramedullary nailing—for the treatment of three-part proximal humerus fractures. Methods: Sixty-six patients aged 60–80 years were retrospectively analyzed across two centers adopting different institutional preferences. Thirty-three patients were treated with minimally invasive plate fixation and thirty-three with intramedullary nailing. The mean age was 67.8 ± 4.2 years, and the mean follow-up duration was 27.2 months. Functional and clinical outcomes were evaluated using the Barthel Index, DASH, Simple Shoulder Test (SST), and Visual Analog Scale (VAS). Operative time, hospitalization length, healing time, and postoperative complications were recorded and statistically analyzed. Results: Intramedullary nailing was associated with shorter operative and hospitalization times and fewer complications. Early SST and VAS improvements favored the nailing group, while long-term outcomes were comparable. Conclusions: Intramedullary nailing represents a reliable and less invasive alternative to plate fixation in the treatment of three-part proximal humerus fractures. It offers shorter operative and hospitalization times, fewer postoperative complications, and faster functional recovery while achieving comparable long-term outcomes. Surgeon experience and familiarity with the chosen technique remain key determinants of success. Full article

Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft–prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 ± 3.8 (74.3% ± 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 ± 5.2 vs. 26.6 ± 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results. Full article

Proximal humerus fractures are common and complex; despite advances, malunion, nonunion, and osteonecrosis remain concerns. Three-dimensional (3D) imaging/printing has emerged to improve classification, planning, and execution, especially in displaced patterns. Methods: Multiple databases have been searched using predefined terms (“proximal humerus fractures/sequelae”, “three-dimensional”, and “3D printing”). Inclusion criteria targeted human longitudinal studies (retrospective/prospective) on 3D-assisted fracture or sequela management; expert opinion, prior reviews, and letters to editors were excluded. Data extracted included the design, the level of evidence (LoE), the sample size, 3D application (diagnostic, planning, intraoperative, and combined), outcomes, follow-up, and complications. Results: Nineteen studies were included (fourteen fractures and five sequelae; 636 and 28 patients, respectively). In fractures, 3D imaging was used chiefly for preoperative planning (57.1%) and diagnostic support (35.7%); no intraoperative PSI was reported. In sequelae, intraoperative/PSI dominated (100%), with planning in 80% and combined uses in 80%. Fracture studies were mostly retrospective (50.0%; LoE III 78.6%), while all sequelae were LoE IV–V (60% of case reports). Standardized outcomes were reported in 42.1% of studies; follow-up was available in 42.1% (means ≈ 18 months). Complications occurred in 14.3% of fracture studies and in none of the sequelae. Conclusions: Three-dimensional printing is primarily applied for planning in fractures and intraoperative guidance in sequelae. While feasibility and potential perioperative benefits are evident, small heterogeneous cohorts and limited outcome reporting warrant larger prospective studies with standardized endpoints. Full article

Background: Megaprosthetic replacement is widely used following tumour resection but remains challenged by periprosthetic joint infection (PJI) and variable functional outcomes. This narrative review aims to summarise current evidence on infection rates, prevention strategies, and functional outcomes following proximal humerus megaprosthetic reconstruction. We hypothesise that antibacterial coatings and improved soft-tissue techniques reduce infection rates and enhance functional recovery. Methods: A comprehensive narrative review of PubMed, Web of Science, and the Cochrane Library was performed using the terms proximal humerus, shoulder, bone tumor, sarcoma, neoplasm, infection, megaprosthesis, and endoprosthetic replacement. Reference lists were screened manually. Case reports and series with fewer than five patients were excluded. Twenty-seven clinical studies (more than 1100 patients; mainly osteosarcoma, chondrosarcoma, and metastatic lesions) were included and qualitatively analyzed. Results: The reported infection rates ranged from 4% to 20%, with higher risk in patients receiving adjuvant therapy. Silver-coated implants reduced PJI compared with uncoated designs (e.g., 11.2% → 9.2% in primary implants; 29.2% → 13.7% in revisions) without systemic toxicity. Alternative antibacterial coatings (e.g., silver- or copper-enriched hydroxyapatite) showed promising early results but remain supported by limited clinical data. Soft-tissue stabilization with Trevira tube or synthetic mesh improved joint stability and did not increase infection risk. Functional outcomes, usually assessed by MSTS or TESS, were moderate to good (≈60–80%) overall, with better scores when the deltoid and axillary nerve were preserved or when reverse total shoulder arthroplasty was possible. Conclusions: Proximal humerus megaprosthetic reconstruction benefits from meticulous soft-tissue handling, selective use of antibacterial technologies, and multidisciplinary management. The current literature is mainly retrospective, heterogeneous, and non-comparative. Prospective multicenter studies are needed to clarify the long-term effectiveness of silver or alternative coatings, soft-tissue reconstruction techniques, and emerging custom-made 3D-printed prostheses. Full article

Background: Displaced pediatric supracondylar humerus fractures (PSHFs) commonly require surgical treatment. Medial pin placement can cause iatrogenic ulnar nerve injury. This study presents a modified, step-by-step cross-pinning technique for PSHFs designed to avoid iatrogenic ulnar nerve injury. Methods: We retrospectively included patients with PSHF (Gartland types III or IV) who underwent closed reduction and percutaneous cross-pinning at our hospital from June 2014 to December 2024. Demographic data, fracture type, and preoperative and postoperative neurological deficits were recorded. Results: A total of 40 patients (16 boys and 24 girls) with a mean age of 6.6 ± 2.2 years (range, 2–14) were included. Most injuries were type III (35/40; 87.5%), whereas five patients (12.5%) had type IV injuries. Our technique resulted in no new cases of postoperative ulnar neuropathy. Conclusions: This study describes a modified medial pin insertion technique for unstable PSHFs. Careful attention to medial pin placement can minimize iatrogenic ulnar nerve injury. Full article

Background: Fractures of the distal humerus (DHFs) represent challenging intra-articular injuries that are often followed by postoperative complications, most notably ulnar neuropathy. There is still debate regarding the best method of handling the ulnar nerve during open reduction and internal fixation (ORIF). Objective: The primary objective was to evaluate the incidence of postoperative ulnar neuropathy (UN) in patients who underwent open reduction and internal fixation (ORIF) for DHFs, comparing anterior transposition (AT) with in situ decompression (ISD) of the ulnar nerve. Additionally, we investigated the influence of AT on individuals presenting with preoperative UN. Methods: A retrospective review was conducted on 68 patients (26 females and 42 males; mean age: 46.3 years) who underwent ORIF for intra-articular DHF between 2018 and 2022. Patients were divided into two groups: anterior transposition (n = 14) and in situ decompression (n = 54). Ulnar neuropathy was evaluated using the modified McGowan classification, and radiographic outcomes were assessed with AO/OTA fracture classification. Results: Sixty-eight patients (26F/42M) were included. The mean age was 46.3 years (20–77 years) and the mean follow-up time was 53 months (36–76 months). The postoperative UN incidence was 30.8% (21/68). Neuropathy was significantly higher in the transposition group compared to in situ decompression (57.1% vs. 24%; p = 0.012). Olecranon osteotomy (36.3% vs. 20%; p = 0.042) and parallel plate configuration (33.3% vs. 12.5%; p = 0.037) were also associated with increased neuropathy risk. Among patients with preoperative ulnar neuropathy (n = 12), functional recovery was more favorable with transposition, where 71% experienced full resolution compared to 60% in the in situ group. Conclusions: Routine anterior transposition of the ulnar nerve during ORIF for DHF is associated with an increased risk of postoperative neuropathy and should be avoided in patients without preoperative symptoms. However, transposition appears beneficial in patients with pre-existing ulnar neuropathy. Surgeons should individualize ulnar nerve management to balance surgical risks and neurological outcomes. Full article

Proximal humerus fractures are frequent injuries that often require internal fixation. Conventional metallic plates, however, present significant drawbacks such as corrosion, secondary removal surgeries, and adverse reactions in patients with metal hypersensitivity. This study evaluates biocomposite plates fabricated from polylactic acid (PLA) and polyvinyl alcohol (PVA), reinforced with hydroxyapatite (HA) derived from sugar industry by-products (BCF) at 10% and 20% concentrations. These composites are compatible with both injection molding and 3D printing, enabling the design of patient-specific implants. Characterization by SEM, FTIR, XRD, and DSC confirmed that BCF incorporation enhances strength, stiffness, osteoconductivity, and biocompatibility. Mechanical testing showed that PVA/BCF exhibited greater tensile strength and stiffness, suggesting suitability for load-bearing applications, though their water solubility restricts use in humid environments and prevents filament-based 3D printing. PLA/BCF composites demonstrated better processability, favorable mechanical performance, and compatibility with both manufacturing routes. Finite element analysis highlighted the importance of plate–humerus contact in stress distribution and fixation stability. Compared with non-biodegradable thermoplastics such as PEI and PEEK, PLA/BCF and PVA/BCF offer the additional advantage of controlled biodegradation, reducing the need for secondary surgeries. Cell viability assays confirmed cytocompatibility, with optimal outcomes at 10% BCF in PVA and 20% in PLA. These results position PLA/BCF and PVA/BCF as sustainable, patient-tailored alternatives to metallic implants, combining adequate mechanical support with bone regeneration potential. Full article

Adding a fibular strut bone graft to locking plate fixation has been introduced to improve stability and prevent varus collapse. The purpose of this study was to perform finite element analysis (FEA) of the biomechanical characteristics of different insertion angles of the fibular strut graft in proximal humerus fractures. Proximal humerus fractures with metaphyseal comminution and instability were simulated by creating wedge-shaped osteotomies medially and laterally for varus and valgus models, respectively. Three-dimensional finite element models were reconstructed from computed tomography images. A locking compression plate with a length of 90 mm (three holes) was applied to the proximal humerus fracture model. Fibular allografts were inserted at 0° and 30° to the humeral shaft. Axial and traction forces of 70°, 90°, and 110° relative to the vertical axis were applied to each model to simulate stress on the plate and graft. At axial loads, stresses in both the plate and the graft were lower when the graft was inserted at 0° than at 30°. Under traction loads, plate stress was lower with 30° insertion. Graft stress was also lower with 30° in most experimental conditions in both the valgus and varus models. These findings suggest that oblique insertion may provide biomechanical advantages under traction forces in unstable proximal humerus fractures. Full article

Background and clinical significance: Paget’s disease of bone involves anomalies of the bone metabolism; however, the presence of tumor-derivate abnormal parathyroid hormone (PTH) levels does not represent one of these disturbances. To our best knowledge, the association with normocalcemic variant of primary hyperparathyroidism has been limitedly reported, and here we introduce such an unusual overlap in a male suffering from osteoporosis. Case presentation: A 71-year-old, non-smoker man was hospitalized for mild, nonspecific dysphagia, asthenia, decreased appetite, and mild weight loss during the latest 2 months. His medical history included cardiovascular conditions and an abnormal PTH level with normal serum calcium under daily cholecalciferol supplements (tested twice during latest 12 months). The lab findings pointed out a normocalcemic primary hyperparathyroidism (PTH of maximum 163 pg/mL, and total calcium of 9.3 mg/dL) caused by a right parathyroid tumor of 1.2 cm, as confirmed by computed tomography (CT). Additionally, CT showed a left humerus lesion suggestive of Paget’s disease of bone, a confirmation that also came from the whole-body bone scintigraphy. The subject presented increased P1NP and osteocalcin, CrossLaps as bone formation, and resorption markers, with normal total alkaline phosphatase. CT scan also detected multiple vertebral fractures and small kidney stones. Zoledronate i.v. (3 mg, adjusted for creatinine clearance) was administered, taking into consideration all three bone ailments (Paget’s disease, high PTH/calcium, and osteoporosis) with further follow-up. Conclusions: This case highlights the following technical notes based on a real-life setting: 1. Despite the mentioned bone diseases, no bone pain was present. Loss of appetite, dysphagia, and asthenia may be a consequence of mineral metabolism disturbances. 2. The panel of blood bone turnover markers levels might be related to both hyperparathyroidism and Paget’s disease; notably, rare cases of Paget’s disease with normal alkaline phosphatase were prior reported. 3. A meticulous differentiation between secondary and primary hyperparathyroidism is required. In this instance, lack of hypocalcaemia and vitamin D deficiency was suggestive of the diagnosis of a primary variant. 4. Kidney stones, osteoporosis, and osteoporotic fractures may be correlated with both conditions, as well, while a dual perspective of the therapy, since the patient was not a parathyroid surgery candidate, included a first dose of zoledronate with consecutive long-term follow-up. To our best knowledge, the co-presence of normocalcemic variant of primary hyperparathyroidism represents an exceptional finding in a patient synchronously diagnosed with Pagetic lesions and osteoporosis complicated with vertebral fractures. Full article

The French Bulldog is a breed predisposed to lateral humeral intercondylar fractures. A transcondylar lag screw combined with an epicondylar pin is most commonly used for their repair. However, improper screw and pin placement is common. This study used a 3D-printed plastic bone model, designed from a 5-year-old 19.5 kg French Bulldog’s humerus. Then, a 3D-printed drill guide was designed specifically for a lateral humeral condylar fracture. The bone models were divided into two groups: the first group included the use of the 3D-printed drill guide during the screw and pin placement, and the second group did not. After implantation, we compared the angle deviation of the transcondylar screw and the epicondylar pin, as well as the exit point translation of the transcondylar screw. The results showed differences between the two groups. The first group exhibited a lower angle deviation than the second group. Additionally, the exit point translation of the transcondylar screw was reduced in the drill guide group. The use of a custom-designed 3D-printed drill guide significantly improved the accuracy of the transcondylar screw and epicondylar pin placement. This advancement could reduce the incidence of postoperative complications. Full article

Background: Hip fractures in geriatric patients represent a major public health burden, with a clinically important subset presenting with concomitant upper extremity (UE) fractures. The independent impact of these dual injuries on clinical outcomes remains incompletely characterized. Methods: A retrospective study of patients aged ≥65 years who underwent surgical treatment for hip fracture at tertiary medical center, between January 2010 and January 2024. Patients were stratified based on the presence of a UE fracture sustained at the same time as the hip fracture. Multivariable regression models were used to assess outcomes, adjusting for age, sex, hip fracture type, and comorbidity burden. Primary outcomes were hospital length of stay and mortality at 30 days and 1 year. Secondary outcomes included readmission rates, revision surgery, and infection complications. Results: Of 7488 patients, 251 (3.4%) had concomitant upper extremity (UE) fractures. These patients had a longer mean hospital stay compared with isolated hip fractures (20.2 vs. 17.5 days, p = 0.047), with no significant difference in 30-day mortality (p = 0.439) and a trend toward lower 1-year mortality (p = 0.058). In the concomitant UE fracture group, operative treatment was associated with longer hospitalization (26.2 vs. 19.2 days, p = 0.05) and higher revision surgery rates (14.0% vs. 3.1%, p = 0.01). Subgroup analyses by fracture type showed similar trends, with longer hospital stays observed in intracapsular fractures with concomitant injury (p = 0.05). Subgroup analysis by UE fracture location showed significantly longer stays for distal radius fractures compared with isolated hip fractures, whereas no significant differences were observed for proximal humerus or other UE fracture locations. Conclusions: Concomitant UE fractures in geriatric hip fracture patients are associated with prolonged hospitalization. Operative management of UE fractures results in longer hospital stays and an increased risk of revision surgery. These findings highlight the importance of tailored perioperative planning and resource allocation for this vulnerable patient group. Full article

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes. Full article

Background: Proximal humerus fractures (PHFs) constitute a significant orthopedic challenge, particularly among the elderly, due to osteoporosis and comorbidities. While surgical intervention is often considered for complex fractures, non-surgical treatment (NST) has gained attention, especially during the COVID-19 pandemic, when surgical resources were limited. This study evaluates the functional outcomes of patients over 65 years old who underwent NST for PHFs during the pandemic. Methods: A retrospective analysis was conducted on patients presenting with 3- or 4-part PHFs at the Hospital Marino di Alghero (Italy) between 9 March 2020 and 18 May 2020. Inclusion criteria included age over 65, conservative management, and a minimum 30-month follow-up. Seven patients were evaluated through radiographic imaging and clinical assessments, including the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and Disabilities of the Arm, Shoulder, and Hand Score (DASH). Functional recovery was analyzed over a 48-month period. Results: The average CSS was 69.4 (SD: 22.3), OSS was 34 (SD: 14.6), and DASH was 27.9 (SD: 30.3), indicating moderate functional recovery. One patient required surgical fixation due to excessive displacement. Tuberosity union was observed in 85.7% of cases, and complications were minimal. NST allowed patients to recover shoulder function while avoiding surgical risks, particularly during the pandemic. Conclusions: NST proved to be a viable treatment for elderly patients with PHFs, yielding satisfactory functional outcomes with minimal complications. The pandemic highlighted the importance of conservative approaches in orthopedic management, emphasizing the need for individualized treatment decisions based on patient comorbidities and fracture characteristics. Full article

At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality registry, including index fractures, fall from standing/walking, preventive factors, Dual Absorptiometry X-ray (DXA) results and treatment status, in addition to risk factors such as chronic diseases. As in many other hospitals and countries, the capacity of the DXA scanner at SUH does not meet the needs of the ageing population. As such, FLS patients should be prioritised for DXA scanning according to their need for anti-osteoporotic treatment. The aims of this study were (1) to identify whether any risk factors are more strongly associated with osteoporosis than others, and (2) to use this information as a tool to prioritise patients for which the decision to initiate anti-osteoporotic treatment should be assessed by a DXA scan. Method: We used software from CheckWare to keep a structured health record, submitting journal text to the health record and data to our fracture quality registry from 1 June 2022 to 31 December 2024. The fracture coverage of the registry, as part of the medical record, was 100%. Both men and women aged over 50 years with fragility-related fractures were included in the analysis, with index fracture having been reported within 24 months prior to FLS assessment. Exclusion criteria: short life expectancy (<3 years), already started on anti-osteoporotic treatment, living in nursing home, age >97 years, or multi-trauma patients. Statistics were calculated using SPSS and logistic regression. The results are presented as odds ratio (OR) and 95% confidence interval (95% CI). Significant differences were considered at a p-value of <0.05. Results: A total of 6974 patients were included, 81% of which were female. After the DXA scan, 5307 of the patients were started on anti-osteoporotic treatment (76%). Patients aged 50–70 years were the largest group. Female patients or those aged 80 years or older had an increased odds ratio (OR) of starting treatment after a fracture. The index fractures included in the logistic regression analysis and were most likely to initiate anti-osteoporotic treatment in the FLS, were vertebral fracture (p < 0.000, OR 3.1, 95% CI: 2.4–4.0), hip fracture (p < 0.000, OR 2.60, 95% CI: 1.9–3.5), costa fracture (p-value = 0.028, OR:1.3, 95% CI:1.0–1.5), pelvic fracture (p-value < 0.000, OR 3.1, 95% CI: 1.8–5.1). Patients with lack of sufficient vitamin D had increased odds with OR of 1.7 (p-value < 0.00, 95% CI: 1.3–2.2) for having osteoporosis compared to the other FLS patients. Fall from standing, walking or sitting increased the odds for osteoporosis treatment (p-value < 0.000, OR 2.8, 95% CI: 2.3–3.3). Conclusions: The listed risk factors for needing treatment were high for most fractures, especially vertebral, hip, and pelvic fractures. Patients aged 80+ years and with a fracture from standing/walking could also start treatment directly, without waiting for a DXA scan. Thus, these patients should be shifted rapidly to FLS and started on treatment without delay. In this way, DXA scanning can be prioritised for patients for whom supporting information is needed regarding the decision to initiate anti-osteoporotic treatment, such as those with proximal humerus, wrist, or ankle fractures. Time to DXA scan could be shortened for these patients and 12 weeks may be achievable. Full article

Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA. Full article